Thank you for your interest in having Dr. Guiliano participate in your upcoming event. Please complete the following form and submit it at least six weeks prior to the event. The Office of the President will notify you as soon as a decision has been made.

Requesting school/college/department:
Sponsor: Name of most senior person making request
Your name:
Your email address:
Event name:
Date:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2013 2014 2015
Time:
Location:
Audience: Check all that apply.	Guests/visitors Potential donor Media NYIT Staff NYIT Faculty NYIT Students NYIT Alumni
Number of attendees:
Significant or notable participants and attendees:
Event agenda: Text box expands.
President's role:	Attend only Q&A Photo Op. Speak Welcome remarks Closing remarks Keynote Number of minutes: Other
President's message points: Text box expands.
Rationale for President's participation: Text box expands.
Post-event support	Thank you notes Photos News release Web posting Other
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