New Student and Family Programs

Application for Distinguished Lecture Fund

We suggest that you print out a copy of the online application after you click submit so you may keep a copy for your files and in case the application fails to transmit.

Please wait for your email confirmation from Gina that your application was received electronically. If you do not receive confirmation within 3 days contact Gina at (615) 898-2454 or ghpoff@mtsu.edu.

Please complete this application in its entirety and click the send button.

1. Enter contact and approval information.

Name of Requester:

Department:

College or
University Area:

Phone:

Campus Box:

Email Address:

Dept. Chair Approval:

Yes No

College Dean Approval:

Yes No

2. Enter proposed speaker/event information.

Name of Speaker:

Speaker Fee:

Amount Request from Distinguished Lecture Fund:

Enter if amount is different than only speaker fee and explain breakdown of funds requested.

Supplemental Funds Available from Department
or College?:

Yes No

If yes, explain.
Please include amount from each department, college or committee.

Potential Topic to Present:

Name of Event:

Date of Event:

use (mm/dd/yy) format

Day of Event:

Time of Event:

use (hh:mm am/pm) format

Venue:

Estimated Audience Size:

Estimated MTSU Student Audience Size:

Classes & Groups Required to Attend:

Who will be Targeted to Attend:

Type of Promotion to be Done for Event:

Other Proposed Activities While On Campus:

   Social Appearances
   Class Appearances
   Other
Please Explain:

Biographical Sketch
of Speaker:

3. Write a summary on how your proposed speaker will address the following criteria: (please be very specific)

Collaboration between multiple departments and/or colleges and how the collaboration will be promoted to each area.
Integration as a course requirement in one or more classes
Availability and willingness to meet with students and others in small groups
Potential for popular appeal
Community interest in the subject matter
Media interest

Summary: