2016-2017 National Officer Video Request Form Question Title * 1. Requested By: Name: * Chapter/Region/State: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Email Address: * Phone Number: * Question Title * 2. Meeting & Location Information: Meeting Name: Meeting Location: Location Address, City, Zip: Meeting Location Phone Number: Meeting Dates: Meeting Theme or Focus: Anticipated Attendance: Question Title * 3. Which member(s) of the 2016-2017 National Executive Council are you requesting? Rylie Seaver, President (IN) Victoria Connor, First Vice-President (CO) Kayla Gullickson, Vice-President of Community Service (SD) Shyamala Subramanian, Vice-President of Competitive Events (NJ) Shelby Lake, Vice-President of Development (IN) Carter Bracht, Vice-President of Finance (NE) Uriel Martinez, Vice-President of Membership (GA) Brittany Hastings, Vice-President of Parliamentary Law (TX) Dedan McFadden, Vice-President of Programs (GA) Lauren Cole, Vice-President of Public Relations (OK) No Preference (National FCCLA will choose someone who is available and able to meet meeting needs) Additional Requests/Information Question Title * 4. Requested Date/Time of Session: Date: Time: Time Zone: Question Title * 5. Presentation Request Information Presentation Type (keynote, workshop, greetings, etc.): Topic: Audience (student, adviser, etc.): Additional Information: Preferred Connection Method (e.g. Skype, Oovoo, Webinar Service, etc.): Connection Account Name/Number (e.g. Skype Username, if applicable and available): Question Title * 6. Once this request is submitted, FCCLA will coordinate with the requested officer(s) to ensure availability and willingness, as well as grant approval from the national office for the officer to present. Following this, both the requester and officer(s) will receive contact information of the other party to begin making arrangements and meeting plans. Please do not make arrangements for the officer prior to receiving further information from FCCLA.By checking this box, the requester verifies that all information above is accurate to the best of their knowledge and they understand national FCCLA must approve the request prior to making arrangements for the officer to present. I agree Done