Vice President for Research, Innovation and Entrepreneurship Event Request Contact InformationName:* Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Email:* Phone Number:Mobile Phone Number:Office/Department/Organization: Are you a UConn employee:* Yes No Event InformationEvent Name: Date: MM slash DD slash YYYY Start Time: : HH MM AM PM End Time: : HH MM AM PM Anticipated Time Commitment:Please identify how long the VPRIE should be in attendance. Audience:Please describe the audience (indicate all that apply) Donors and Friends UConn Alumni Elected Officials Community Members Faculty Staff Students Retirees Location:* Indoor Outdoor Venue:* Address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Event DetailsWHEN FILLING OUT THE FOLLOWING INFORMATION, PLEASE BE PRECISE. INCLUDE STATISTICS, HISTORY, PAST/FUTURE EVENTS, ETC., WHEN APPROPRIATE. ATTACH ADDITIONAL PAGES AND DOCUMENTS AS NECESSARY.Purpose of the event:*Program agenda description:Program AgendaOptional upload of program agenda as a pdf or Word docAccepted file types: pdf, doc, docx, Max. file size: 2 MB.Please describe the nature of the Vice President for Research, Innovation and Entrepreneurship’s role: No remarks necessary Welcoming remarks Short Remarks Speech Keynote Address Panel Discussion If the VPRIE is able to attend, you should be prepared to provide the following (draft remarks/data, audience takeaways).Examples of remarks:If the VPRIE will deliver remarks, state the nature of her remarks.Issues/subject matter that the VPRIE’s remarks should focus on:Please include as much relevant information as possible.The VPRIE’s remarks should seek to accomplish the following:Duration the VPRIE should plan on speaking: Emcee for this event: Name and title of person who will introduce the VPRIE: Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Suffix Is the VPRIE being asked to introduce someone? Yes No List of other speakers participating: Person(s) in the audience that the VPRIE should acknowledge: Should the VPRIE stay for the entire duration? Yes No If the VPRIE is not able to attend, would you like to have a delegate attend instead?Delegate’s attendance is pursuant to their availability. Yes No Dress/Attire Business Casual Formal/Black Tie Will a meal be provided? Yes No All media inquiries and requests should be handled through University Communications. Has this been done already? Yes No N/A, no media will be present at the event Will the event be recorded? Yes No If you have any additional attachments please include them here:Allowed file types: doc, docx, jpg, png, pdf Drop files here or Select files Accepted file types: doc, docx, jpg, png, pdf, Max. file size: 2 MB. PLEASE NOTE: Due to the nature of the VPRIE's schedule, availability is subject to change.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.