Superintendent Event Request Form

Superintendent Event Request Form
Please complete and submit this form to request State School Superintendent Richard Woods' attendance at your event.

Please be aware that, due to scheduling constraints, Superintendent Woods is not able to attend all requested events, and submission of this form does not constitute a confirmation of attendance at your event. Staff from Superintendent Woods' office will follow up with you using the contact information you provide.

While we will consider all scheduling requests, we recommend that you make requests at least 30 days in advance, if at all possible.

Should you have any questions, please send an email to scheduling@doe.k12.ga.us.
Basic Event Information
Event Name*
Organization Sponsoring Event*
Purpose of the Event*
Expected Number of Attendees*
Event Date*

MonthDayYear
Date
Event Start & End Time*
Time Superintendent is Needed (if not all)
Event Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event theme, if any
Primary Event Contact
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Cell or Alternate Phone Number (if applicable)
Please enter a valid phone number.
Other Event Contact (required - in case of emergency)
Name*

First NameLast Name
Email*
example@example.com
Phone*
Please enter a valid phone number.
Media Relations Contact (if applicable)
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Additional Event Information
Describe the role of the State School Superintendent at your event:*
Provide any details about the group/audience that would be helpful to the Superintendent (i.e. background on the organization, organization website, issues of interest to the audience, etc.):
Other officials or special guests attending:
Event Attire*
Speaking Information

Note: these fields are required if you are requesting that the Superintendent speak at your event.
Are you requesting that the Superintendent speak/provide remarks at your event?*

YesNo
If speaking -- requested speech length:
If speaking -- A/V equipment available for PowerPoint presentation:

YesNo
Contact Who Should Receive Superintendent's PowerPoint:
example@example.com
If speaking - list any specific issues the group would like the Superintendent to address:
Would you like for the talk to be inspirational/motivational, informational/technical/policy, or both?
What would you consider a "win" for the Superintendent's remarks at this event?
Is there anything else the Superintendent can do to add value for you and/or others attending the event?
List any other individuals invited to speak, including names and titles:
Lodging
To help with travel arrangements, we ask -- if your event is held at a hotel or conference center -- that you reserve a room for Superintendent Woods at the time of your request. This is not a requirement, but it helps ensure availability since hotels are often fully booked once attendance is confirmed. Please note that the Georgia Department of Education will cover all costs for the room.
Are you able to reserve a hotel room for the Superintendent?*

YesNo
Final Event Information
If the Superintendent cannot attend your event, would you like another GaDOE representative to attend/speak?*

YesNo
Any additional information you would like to provide:
Should be Empty:

Superintendent Event Request Form

Basic Event Information

Primary Event Contact

Other Event Contact (required - in case of emergency)

Media Relations Contact (if applicable)

Additional Event Information

Speaking Information

Lodging

Final Event Information