Event Date Request

Is your event date contingent on the availability of the Superintendent or Board Member? Or will the Superintendent or a Board Member be a part of the program, whether as a speaker or to provide awards?*

YesNo

You indicated you do not need the Superintendent or Board member to serve as a part of your program; do you want to request they attend if schedules permit?

Yes, Superintendent and BoardYes, Superintendent OnlyYes, Board OnlyNo

Are you a community organization who is requesting Mr. Hendrick or a Board member to attend your invite only event?

Yes, Community Organization.No, I represent PCSB or Pinellas Education Foundation.

Name of Person Requesting Event*

First NameLast Name

Email*

[email protected]

Department or Organization*

Phone Number*

Please enter a valid phone number.

Event Name/Title*

Brief description or purpose of the event.

Event focus or primary audience*

Date and Time of Event*

Date

Hour MinutesAM/PM Option

Event Type:*

In-Person OnlyIn-Person with Live BroadcastVideo Message

Approximate Length of Event*

Hours and minutes

Event Location*

School/ Location Name

Street Address

City

What role will the Superintendent serve as this event? Check all that apply.*

Attend onlyAttend, participate and provide recognition (handshake, provide certificates, photo, etc.)To bring greeting or welcome (2-3 minutes)To be the keynote or featured speaker (5-15 minutes max)To close the event (1-2 minutes)No representation needed

Do you need Board member participation, if so, please indicate in what capacity?*

Attend onlyAttend, participate and provide recognition (handshake, provide certificates, photo, etc.)Attend and bring greetings (2 to 3 minutes speaking).No representation neededAttend, bring greetings AND participate in program (handshake, certificates, etc.)

Please provide 3-5 key points to be included in the speech. NOTE: These items should be exclusive to this speech and not included in other speakers talking points.

If virtual event – will their remarks be live or taped?

Remarks LiveRemarks Taped

Do you need support from Strategic Communications for this event?*

YesNo

Submission Date

Date