Request for Chancellor to Speak

Thank you for completing this form. This will allow Chancellor Zerwas ad interim to quickly consider your request. If he is able to participate, we will send a separate confirmation message.

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Requestor Information

Name of Host Organization

Contact Name

Phone Number

Email Address

Is requesting organization a unit or department within a UT institution?

Name and Title of Person who Authorized Request

Event Information

Event Title

Location of Event (please note if virtual)

Type of Remark

Event Date

Event Start Time

Event End Time

Requested Length of Chancellor's Remarks in Minutes

Estimated Number of Participants

Brief Description/Purpose of Event

Brief Description of Audience

Topic/Key Message

Proposed Order of Program

Thank you for your submission, we will respond soon.