Section I Name of Organizer/Group Status - Select -StudentFacultyStaff Email Phone Section II Section II Title/Topic and Brief Description of Event Proposed Date and Start/End Time of Event Event Type (Lecture, Q&A, Seminar, etc.) Proposed Location Anticipated Attendance (#) Who is Attending? (Organization members only? Open to NDMU community? Alumni or other invited/registered guests? Open to the general public?) Where/how will the event be advertised? Section III Section III Number of Speaker(s) - Select -12345 Speaker 1 Information Name of Speaker(s) Speaker(s) Contact Information (Email/Phone) Speaker(s)’ Organization or Other Affiliation(s) Please provide links to biographical and other information about the speaker(s) Has the speaker attended an event at NDMU before? If known, please provide details (when, the topic, etc.) Has the speaker or topic attracted controversy in the past? If yes, please summarize and include reference links of related media coverage, if applicable. To your knowledge, has the speaker presented at other colleges or universities or other venues, and, if so, has there been significant media interest? Have there been any incidents of protest/disturbance or alleged illegal activities? Has the right to speak ever been refused/denied? Speaker 2 Information Name of Speaker(s) Speaker(s) Contact Information (Email/Phone) Speaker(s)’ Organization or Other Affiliation(s) Please provide links to biographical and other information about the speaker(s) Has the speaker attended an event at NDMU before? If known, please provide details (when, the topic, etc.) Has the speaker or topic attracted controversy in the past? If yes, please summarize and include reference links of related media coverage, if applicable. To your knowledge, has the speaker presented at other colleges or universities or other venues, and, if so, has there been significant media interest? Have there been any incidents of protest/disturbance or alleged illegal activities? Has the right to speak ever been refused/denied? Speaker 3 Information Name of Speaker(s) Speaker(s) Contact Information (Email/Phone) Speaker(s)’ Organization or Other Affiliation(s) Please provide links to biographical and other information about the speaker(s) Has the speaker attended an event at NDMU before? If known, please provide details (when, the topic, etc.) Has the speaker or topic attracted controversy in the past? If yes, please summarize and include reference links of related media coverage, if applicable. To your knowledge, has the speaker presented at other colleges or universities or other venues, and, if so, has there been significant media interest? Have there been any incidents of protest/disturbance or alleged illegal activities? Has the right to speak ever been refused/denied? Speaker 4 Information Name of Speaker(s) Speaker(s) Contact Information (Email/Phone) Speaker(s)’ Organization or Other Affiliation(s) Please provide links to biographical and other information about the speaker(s) Has the speaker attended an event at NDMU before? If known, please provide details (when, the topic, etc.) Has the speaker or topic attracted controversy in the past? If yes, please summarize and include reference links of related media coverage, if applicable. To your knowledge, has the speaker presented at other colleges or universities or other venues, and, if so, has there been significant media interest? Have there been any incidents of protest/disturbance or alleged illegal activities? Has the right to speak ever been refused/denied? Speaker 5 Information Name of Speaker(s) Speaker(s) Contact Information (Email/Phone) Speaker(s)’ Organization or Other Affiliation(s) Please provide links to biographical and other information about the speaker(s) Has the speaker attended an event at NDMU before? If known, please provide details (when, the topic, etc.) Has the speaker or topic attracted controversy in the past? If yes, please summarize and include reference links of related media coverage, if applicable. To your knowledge, has the speaker presented at other colleges or universities or other venues, and, if so, has there been significant media interest? Have there been any incidents of protest/disturbance or alleged illegal activities? Has the right to speak ever been refused/denied? Please provide any other notable details about the proposed NDMU hosted event including, to your knowledge, whether there is any media interest, any known security threats, risk of protest/disturbance, or risk of illegal or controversial action by the speaker or attendees? Section IV Section IV I can confirm that the details on this form are correct to the best of my knowledge. I am aware of, and accept that restrictions which may be applied to the proposed event in line with the University’s Freedom of Speech and Expression and Related Policies. I can confirm that the details on this form are correct to the best of my knowledge. I am aware of, and accept that restrictions which may be applied to the proposed event in line with the University’s Freedom of Speech and Expression and Related Policies. * Organizer Signature Date Procedures Procedures In accordance with NDMU’s Speaker Policy, a Request for Approval of Off-Campus Speaker Form generally must be submitted to the appropriate approval authority at least ten (10) business days prior to the event. In special circumstances, at his or her sole discretion, the approval authority may waive the ten (10) day business day requirement.
