* 1. Name:

* 2. Email:

* 3. School:

* 4. Graduation Year:

* 5. Affiliation:

* 6. Which topic(s) would you like to hear discussed on your campus?

* 7. Which AEI scholar would you like to request to make this event happen? Feel free to consult our online list, http://www.aei.org/scholar/. Please list more than one.

* 8. Describe your thoughts on the setting and timing for this event. What will it look like? How many will attend? What date/time of year are you considering?

* 9. What student groups, organizations, committees, or departments would you collaborate with to make this event a success?

* 10. Describe in a few sentences why you think that this particular topic is important to bring to your school.

* 11. Record of success – please describe past successful events organized by this group.

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