2015-2016 National Officer Video/Webinar Request Form

Question Title

* 1. Requested By:

Name: *

Chapter/Region/State: *

Address: *

Address 2:

City/Town: *

State: *

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 2015-2016 National Executive Council are you requesting?

Josh Sorbe, President (SD)

Allyson Monson, First Vice-President (SD)

Gabriella Cutruzzula, Vice-President of Community Service (OK)

Stephanie Zhang, Vice-President of Competitive Events (NJ)

Monica Jones, Vice-President of Development (TX)

Rohit Iyer, Vice-President of Finance (NJ)

Nathon Taylor, Vice-President of Membership (WY)

Raniel Mendoza, Vice-President of Parliamentary Law (NC)

Garrett Christiaens Vice-President of Programs (MT)

Makayla Hendricks, Vice-President of Public Relations (UT)

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