If you would like for Chancellor Riley to create a video message for an event you are hosting, please complete and submit the form below within two weeks of the event. Submission of the form does not guarantee Chancellor Riley’s participation. A confirmation email will be sent from the Office of the Chancellor once the request has been reviewed and approved. If you have any questions, please contact the Office of the Chancellor at 479-788-7007. Event Name (required): * Date of Event (required): * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022202320242025 Due Date of video: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022202320242025 Requested length of video: Enter a number that represents the duration (in minutes). Email address to submit video: Brief Description and purpose/theme of the Event (required): * Talking points of video message (required): * Estimated Number of Attendees: Numbers only. Other characters will not be accepted during form submission. Description of Attendees: Additional instruction for video: Point of Contact information Contact Person for the event (required): * Cell phone number: Email (required): * Name of requesting department or organization (required): * Additional information: Information upload: Along with this form, please send a pdf of your agenda, program, talking points, invitation, or any other information that will be needed for this event. (Only PDF documents or PNG images accepted).Files must be less than 2 MB.Allowed file types: png pdf. Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.