Before We Start: Please read before completing this form: You should not fill out this Contract Request Form until your information is final. PLEASE DO NOT FILL OUT THIS FORM UNTIL ALL OF YOUR DETAILS ARE FINAL. Nothing on this form should be tentative or left unanswered. ** Please note that students may NOT submit this form, only Deerfield employees can. **
Section 1: Guest Speaker Information Guest Speaker Name*
First
Last
Guest Speaker Mailing Address* **This must be the Guest Speaker’s personal mailing address (what will be shown on their W-9 Form), not their work address**
If the guest speaker has additional contacts, please list them here: (Additional contacts may include an assistant or agent that will be arranging the speaker’s visit on their behalf.)
Will the guest speaker be providing the Academy with a contract?* Guest Speaker Contract* Upload the Guest Speaker's contract here.
Type of Guest Speaker (please select one) Speaker types:
**Classroom/Academic Guest Speaker (approved by the Dean of Academic Affairs) -Select this for a speaker that is primarily visiting a class.
Section 2: Requesting Faculty/Staff Member Information Faculty/Staff Name*
First
Last
Your department (select all that apply to this visit)* E.g., If your guest is visiting American Studies, you should select English and History & Social Science. The dept. chair will receive a copy of your request. If this visit does not apply to or involve academic departments, please select that option.
Are you the guest speaker’s on-campus contact?* The on-campus contact is the individual who the speaker should contact with questions about the event, and who Finance should contact if they have questions about the visit.
Section 2.5: Contact On Campus Information On-campus contact name*
First
Last
Section 3: Event Information Brief Description of Guest Speaker and their Engagement* Please write a sentence or two that summarizes the speaker’s visit. This should be short; you will provide more details later on in this form.
Select one:* Visit START Time* Visit END Time* Will this visit be VIRTUAL or ON-CAMPUS?* You will now need to provide us with a DETAILED schedule/itinerary, with a brief description of each event. This schedule will be more substantial if the speaker is coming to campus and/or participating in several activities, but it can be quite short if the speaker is visiting virtually General guidelines:
Choose an option for providing us with your guest's DETAILED schedule/itinerary* DETAILED schedule/itinerary, with brief description of each event.*
Upload your guest's DETAILED schedule/itinerary, with brief description of each event.* Will the event/guest be recorded (video or audio)?* You should select “yes” if faculty/staff, students, and/or Communications will be recording any formal or candid videos or audio.
Will the event/guest be photographed?* You should select “yes” if faculty/staff, students, and/or Communications will be taking any formal or candid photographs.
Will the event/guest be livestreamed?* You should select “yes” if the event will livestreamed in any way.
Section 3.5: Accommodations Information This section must be completed if the guest speaker is visiting on-campus, in-person. Virtual visits do not require this information.
Will the speaker require housing?* Will the speaker arrange their own housing, or will it be arranged by the Academy?* Will Deerfield be reimbursing the speaker for housing, or is this included in the honorarium?* Housing payment* Will the speaker require meals?* Meal details (select one)* Will Deerfield be reimbursing meal costs accrued off-campus or is this included in the honorarium?* Will the speaker require transportation?* Will the speaker provide their own transportation, or will it be provided by the Academy?* Will travel expenses be reimbursed or included in the honorarium?* Please provide transportation details:* Include expected transportation type and approximate pick up/drop off time & location. Note that the requesting faculty member is responsible for arranging all transportation and conveying exact details to the guest speaker. You do not need to book travel accommodations prior to filling out this form, but you will need to once the contract is signed.
Section 4: Honorarium Information Will the speaker receive an honorarium?*
Section 5: Additional Information We ask that you allow at least 14 days before your speaker’s visit for the contract to be completed (e.g., if your guest speaker’s visit is on January 15, you should submit the Contract Request Form no later than end-of-day January 1). Please let us know if you are meeting this deadline:* If you have any special requirements for this visit/event, please provide details: Please note that you are responsible for contacting the appropriate office on campus (e.g., Physical Plant, Communications, ITS, Dining) if you require any of their resources/services.
I understand that all information on this form should be finalized information. I understand that I can’t add/subtract extra events or activities to/from the guest speaker’s itinerary at the last minute (unless there is an extraordinary circumstance like a snowstorm, illness, etc.). I have planned ahead, made a schedule/itinerary, and I will adhere to it.* What happens next? ** Remember to click the “submit” button to submit your request, and please don’t close this window until you receive an on-screen confirmation message!
To ensure your request is received, please don’t close this window until you receive an on-screen confirmation message!