Speaker Approval Form

Diocesan Office / Parish / School(Required)

Event Contact Person(Required)

Phone(Required)

Email(Required)

Please check all that apply:

The person named below is a(Required)

Priest

Deacon

Religious

Lay Person

The person is coming into the Diocese(Required)

At the request of a Diocesan entity

At the request of the speaker

This person will be working with minors(Required)

Yes

Event Name(Required)

Description of Event(Required)

(examples: retreat, conference, parish mission, etc.)

Date of Event(Required)

Location of Event(Required)

Name of Speaker(Required)

Title / Position of Speaker(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Diocese of Speaker (if known)

Religious Institution or Employer of Speaker(Required)

Name of Reference of Speaker (Ordinary or Delegate, Religious Superior, Pastor)(Required)

Please give a brief description of the topics to be presented(Required)

Additional Relevant Information

Signature of Pastor or Administrator Hosting Speaker(Required)

Today's Date(Required)

Printed Name of Pastor or Administrator(Required)

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