OVCHA Speaking Engagement Request Form Speaking Engagement Request Form Heading link Copy link Step 1 of 4 0% The Vice Chancellor for Health Affairs (and other leaders in the OVCHA) are often asked to speak at internal university and external community engagements. Please complete the following form as best as possible to submit a speaking engagement request to the office for review. Please note that all speaking engagements are subject to the schedule and availability of the leader requested. Before completing the below speaker request form:Please reach out to the Executive Assistant for the Vice Chancellor for Health Affairs to confirm availability, at 312-355-1607 or VCHA@uic.edu.Your Contact InformationContact name(Required) First Last Contact phone(Required)Contact email(Required) Enter Email Confirm Email Event DetailsAre you requesting the Vice Chancellor for Health Affairs?(Required) Yes No If no, who are you requesting?(Required) Event name(Required) Unit sponsor for event(Required) Date of event(Required) Month Day Year Location of event (including address)(Required)Start time of event(Required) Hours : Minutes AM/PM AM PM AM/PM Does the speaker need to stay for entire event?(Required) Yes No Start time of program(Required) Hours : Minutes AM/PM AM PM AM/PM Describe the focus/goal of the event.(Required)How many people are expected to attend?(Required)Describe the intended audience.List any University Officers or external VIPs.Provide a brief history of the event. Event FormatLength of speaker remarks:(Required) Who introduces the speaker?(Required) Will the speaker introduce someone else in the program?(Required) Yes No Are presenters using slides (.ppt) or speaking from notes?(Required) Using Slides (PPT) Speaking from Notes AttachmentsE.G., program, agenda, etc.Max. file size: 15 MB. ContentWhat is the goal of the speaker's appearance at the event?(Required)List the 3-5 bullet points the speaker should address, include background information.(Required)Please include the topics or themes that OTHER speakers in the program will be covering.Will the speaker be expected to answer audience questions or engage with panelists?Anything else the speaker should know about for a successful event?