IEEE SPS Distinguished Lecturer (DL) or Distinguished Industry Speaker (DIS) Request Form

Please complete the below form with all of the required information to host a DL / DIS at your Chapter.

General Recommendations: Each DL / DIS stays for the nights necessary to deliver the lecture only (normally two nights max.)

The annual budget per Chapter is US $3500 to cover DL Tours and a separate US $3500 to cover DIS Tours.

If there will be multiple Chapters participating in a DL/DIS Tour, please indicate this and submit this form separately for each participating Chapter.

Please note that all funding requests should be made in USD $.

If you have any questions, please contact sp-lecturers@listserv.ieee.org

Chapter Name*

Chapter Region*

Select

Submitter Name*

Submitter Email Address*

Chapter Chair Name*

Chapter Chair Email*

DL / DIS Name*

DL / DIS Email*

Non DL/DIS Biography or CV

Please upload the biography or CV for review.

Drag and drop files here or

Part of a Multiple-Event?

Will the DL / DIS take part in a multiple events held within the Chapter?

Select

Part of a Multiple-Chapter Tour?*

Will the DL / DIS travel to other Chapters as part of a multi-Chapter tour?

Select

Participating Chapters*

Please list the full name (no abbreviations) of all Chapters participating in this tour. If there are no other participating Chapters, input "None." NOTE: All participating Chapters MUST submit a separate request form for budget approval.

Are the participating Chapters splitting the expenses equally?*

Select

Are you requesting a DL or DIS?*

If "Other Lecturer/Speaker" is selected, please upload the potential Lecturer/Speaker's biography or CV for review and approval.

Select

Arrival Date*

Departure Date*

Lecture Date(s) and Location(s)*

Lecture Title*

Airfare Total*

Please indicate the total cost of the DL / DIS airfare for this tour. If this is a Multiple-Chapter tour, please list costs per Chapter.

Hotel Stay*

Please indicate how many nights the DL / DIS will stay in the hotel.

Hotel Cost*

Please indicate the cost per night and grand total for the Hotel stay. If this is a Multiple-Chapter tour, please list costs per Chapter.

Meals Cost*

Please indicate the cost per day and the expected grand total for the DL / DIS only. If this is a Multiple-Chapter tour, please list costs per Chapter.

Local Transportation Costs*

Taxi, train, etc. If this is a Multiple-Chapter tour, please list costs per Chapter.

Other costs*

Please indicate any other costs associated to this DL / DIS Tour. If this is a Multiple-Chapter tour, please list costs per Chapter.

Approved Estimated DL Expenses*

Please indicate the total cost for your Chapter for the proposed DL Tour.

Approved Estimated DIS Expenses*

Please indicate the total cost for your Chapter for the proposed DIS Tour.

Are you requesting support for a social function?*

Chapters have an annual allotment for $500, dispersed on a reimbursement basis.

Select

Amount Requested for Social Function

Total Chapter Expense

Please provide a detailed description of what the funding will be used for.

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