Industry Connection Request Form

* fields are required

Contact Information

I am a : *

First Name: *

Last Name: *

Email: *

Phone Number: *

Course Name: *

Speaking Engagement Details

Many industry professionals require one month notice prior to a speaking engagement, so please make your request with as much lead time as possible. Please note, the availability of industry professionals may vary based on their schedule.

Preferred Date

Campus: *

Building & Room Number: *

Date: *

Start Time: *

End Time: *

Format: *

In-PersonVirtual

Expected Audience Size: *

Alternate Date

Campus: *

Building & Room Number: *

Date: *

Start Time: *

End Time: *

Format: *

In-PersonVirtual

Expected Audience Size: *

Type of Presentation: *

Classroom PresentationNetworking EventPanel

Preferred Industry Professional:
(First Choice)

Industry Professional's Name: *

Topics: *

Preferred Industry Professional:
(Second Choice)

Industry Professional's Name:

Topics:

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