Colloquium Speaker Proposal Form

Speaker Proposal Form

Please complete the form to reserve a spot for colloquium guests.
This form is to be completed and submitted only with the authorization of a member of the Chemistry Department Colloquium Committee in order to provide a scheduled date for the talk and to pre-authorize reimbursement.

* Required field

General Area *

ana bio edu env inorg mat org phys theor Grad Student Green Chemistry Initiative

Speaker's name *

Speaker's Affiliation *

Address *

E-mail address *

Phone *

Fax

Colloquium title *

Speaker Classification *

Local Not Local Opportunity Other (specify)
For opportunity speakers, only hotel and meal costs can be reimbursed by
the colloquium committee.

Proposed date of colloquium lecture (Fridays) *

Proposed time of lecture
(10 am if possible) *

Lecture location *

Davenport 3rd Floor East/West (up to 35 attendees)
Alternate room (more than 35 attendees)
Other (specify)

Host *

Note: No funding is permitted for SGS external examiners

A. For Colloquia funded by the department, please include estimated expenses
(include air travel estimate documentation from Expedia.ca or Aircanada.com)
To estimate the expense for a speaker who will be travelling to the Department by automobile, use $0.47/km

Air or Rail ticket or automobile mileage *	$
Do you require a hotel? *	Yes No
If yes above, please enter the Hotel dates in yyyy/mm/dd format	to
Meals (Up to $300, not covered for internal speakers)	$
Taxi/Airport Bus (Up to $100)	$
Other:	$
Total Requested	$

B. If departmental funds are not being sought, please check here.
Please indicate source of funds *
Are you arranging other local visits for the speaker to share costs? *	Yes No
If yes, where?
Submitted by (Enter the email address i.e. user@utoronto.ca) *

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Speaker Proposal Form