Oklahoma State University Government Relations Engagement Form

Welcome and thank you for taking time to complete this short form, which provides Oklahoma State University Government Relations staff with important information about faculty, staff and student engagement with state and federal elected officials, their staff or other governmental officials.

Contacts
State Affairs - Karlee Belle Gholson karlee.b.gholson@okstate.edu
Federal Affairs - Derek Osborn derek.osborn@okstate.edu

Note for federal engagement requests: please submit this form before initiating any federal delegation outreach and you will be contacted with information regarding scheduling.

Engagement Type

Engagement Type Oklahoma Government Affairs Federal Government Affairs
Name Name First Last
Title
Department
Email
Cell Phone Number Cell Phone Number - ### - ### ####
Which campus/organization will you be representing for this opportunity?

Which campus/organization will you be representing for this opportunity? Oklahoma State University Oklahoma State University Center for Health Sciences (OSU-CHS) Oklahoma State University Institute of Technology (OSUIT) OSU-Oklahoma City (OSU-OKC) Oklahoma State University-Tulsa (OSU-Tulsa) An organization/association not affiliated with OSU (Please provide name)
Please select the entry that best describes your engagement.

Please select the entry that best describes your engagement. Traveling to Oklahoma City Traveling to Washington, D.C. Traveling to another location Participating in/Hosting a virtual meeting Hosting elected/state official on campus Hosting federal official/delegation on campus
Why are you participating in this opportunity?
With whom are you requesting meetings?
What are the dates of your trip/program?
Are university resources being used for expenses (hotel, food, airfare, mileage, etc.)?

Are university resources being used for expenses (hotel, food, airfare, mileage, etc.)? Yes No
Have you participated in this type of engagement before?

Have you participated in this type of engagement before? Yes No
Have you already notified your dean/department head/supervisor or student organization advisor about this opportunity?

Have you already notified your dean/department head/supervisor or student organization advisor about this opportunity? Yes No
Please upload any documents that have been provided to you for this opportunity, including key messaging or talking points, meeting agendas, requested meetings or other supplemental materials.

Attach Files