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Speaker Attendance Request Form

Thank you for your interest in having a member of the Chancellor's Executive Leadership team attend or speak at your event. To assist the Office of Alumni Relations in best serving your needs, please complete and submit the following form. Please submit as much information as possible when completing the request and keep us abreast of any changes or modifications in your plans.

Please note: A two (2) week time-frame for consideration of your request is required by the requested Division. (As a best practice, please send requests at least two months prior to the date of your event).

Event Information

NOTE: Red asterisk (*) indicates a required field.
Requestor/Coordinator Name *
E-Mail *
Title *
Phone Number *
Event Name *
Sponsoring Organization *
Date of Event *
Event Start Time *  
Event End Time *  
Name of NCCU Faculty/Staff Member Requested *
Alternate NCCU Faculty/Staff Member Requested *
Are you an NCCU faculty/staff member or a student? * Yes, I'm faculty/staff   Yes, I'm a student   No

Event Details

Purpose of Event and Requested NCCU Faculty/Staff Member Role *
Expected number of attendees *   
Event Location Details *
Will a meal be served? * Yes   No
Will a photographer or videographer be present? *
Yes   No
Intended Use of Photos/Video
Will news media be in attendance? * Yes   No


NCCU complies with Title IX of the Education Amendments of 1972, which prohibits discrimination on the basis of sex in all programs and activities (including sexual harassment and sexual violence) in the University's educational programs and activities. For additional resources or to file a Title IX complaint, visit the NCCU's Title IX webpage.
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