CLASSROOM GUEST SPEAKER FORM
Faculty members who invite a guest speaker to their classroom that is not employed by the Chabot-Las
Positas Community College District are required to fill out the following form. This form must be
completed and turned into your designated Academic Dean two weeks prior to activity date.
Date Prepared: _______________ Submitted By:_____________________________________
Guest Speaker’s Name: _______________________________________________________________
Speaker’s Official Position: ____________________________________________________________
____________________________________________________________________________________
Speaker’s Contact Number: ____________________________________________________________
Faculty Contact Number/E-mail: _______________________________________________________
Course Name:___________________________ CRN: ______________
Date of Visit: ___________________________ Course Time: _____________________
Course Room Number/Location: _______________________________________________________
Discussion Topic: _____________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Please checkmark the following items or additional assistance needed:
Temporary Parking Pass Podium Lectern
Equipment & Technical Support [Contact Sherman Lindsey at 424-1652]
ADA accommodations needed*: ______________________________________________________
*(requests for accommodations must be submitted 72 hours before the event)
Change of Room/Venue [Contact Division Senior Administrative Assistant]**
**Note that a Field Trip Form must also be filled out and attached for class time change of venue.
APPROVAL:
Date received by Division Office: _____________________
Approval of Dean: ______________________________________________ Date: __________________
Revised: 11/30/17
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