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This form is for internal use ONLY. If you are a faculty, staff or administrator from Touro University California or Touro University Nevada and have an event you think Shelley should attend, someone she should meet, an organization she should speak to, this form will help with scheduling.
Suggested by:
*
Name of TUC or TUN faculty, staff or student providing the suggestion.
Type
Meeting
Special Event
Forum/Conference
Fundraiser
Reception
Graduation
Tour
Speech/Featured Speaker
Media interview
Other
Location
Nevada campus
California Campus
off-campus, Nevada
off-campus, California
Other location
If off-campus, please provide address below.
Date of event
Date Format: MM slash DD slash YYYY
If you have options on dates that you are available, please note the preferred date here and provide additional date options in the text field below.
Start time
:
HH
MM
AM
PM
End Time
:
HH
MM
AM
PM
Please indicate if meeting includes a meal
None
Breakfast
Lunch
Dinner
Hors D'ouevres
Timeframe of required attendance
Please provide the time frame of required attendance. I.E.: if the event is eight hours, but you only need an attendee from 1:00 - 3:00, please note that here.
Requested attendee(s)
*
CEO only
CEO & Spouse
CEO & Provost
CEO & Faculty/Admin
CEO designee
Provost
Dean
Faculty
Admin/Staff
Section Break
Contact Name for meeting
*
Who would we contact to schedule a meeting, make reservations, etc?
Daytime phone
(###)###-####
Secondary Phone
(###)###-####
Email
Enter Email
Confirm Email
Name of Organization or Company
Name of Meeting/event
*
Sponsor(s) of event
Please provide complete address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Purpose of meeting
*
Please provide as many details as possible.
Format of meeting/event
Is there an agenda, program, etc?
Estimated number of people attending
Names of attendees
Column 1
Column 2
click the + box at the right to add up to a total of 20 names
Other speakers/VIP's
Column 1
Column 2
click the + box to the right to add up to a total of 20 names
Touro Goal or Objective
What can Touro achieve by this contact? A partnership, donation, community visibility, etc?
Specific Ask
Detail what Shelley or the executive team member should ask for. What is the need that Touro has that this contact could help with? Donations for? Funding of? Etc
Briefing notes
Other information that may be helpful -- personal connection, audience information, documents that could be provided for background, etc..
Name
This field is for validation purposes and should be left unchanged.