George Mason University - Community Relations

Connecting the University with the Community

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Community Relations | 4400 University Dr. | Mail Stop 2D5 | Fairfax, VA 22030-4444

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Faculty / Staff / Alumni Participation Form

If you are a Mason alumnus/alumna, or a current or retired member of Mason's faculty or staff, and would like to participate in the Mason Speakers program, please complete the form below. All speakers are involved on a volunteer basis. Speaking engagements are made by the Office of Community Relations and free of charge to community organizations.

For more information about the program, or to notify us of a problem with submission of this form, please contact Sarah Gallagher, Mason Speakers Coordinator, via email or by calling (703) 993-8761.


1. Name

2. Mason Employee (Y/N)? (If No then please skip ahead to number 7)

3. Title

4. Department

5. Campus Mail Stop Number

6. Direct Mason Supervisor

7. Direct Work Phone

8. Home Phone

9. Cell Phone

10. Email Address

11. Mailing Address (please enter only if you are not a Mason Employee)

12. City, State, Zipcode (please enter only if you are not a Mason Employee)

13. Retired (Y/N)?

14. Mason Alumnus/a (Y/N)? (If No then please skip ahead to number 17)

15. Graduation Year (format: yyyy)

16. Degree

17. Biography (Please submit a one-paragraph biography for introductions)

18. Topic Title

19. Description (please limit to a short paragraph)

20. Categories
Please check no more than three

American Culture
The Arts (includes Film Studies, Theater)
Business and Finance (includes Bankruptcy, Creditors Rights, Estate Planning, International Business, Management, Stock Market, Taxes)
Childhood Development and Parenting
Communication (includes Conflict Resolution, Language, Media, Public Speaking, Team Building)
Crime/Violence (includes Domestic Violence)
Cultural, Social and World Issues (includes Women's Issues)
Economic Development
Education and Teaching
George Mason University
Government and Politics
Health, Nutrition, Exercise and Sports
Human Resource Management/Personnel
Judaic Studies
Law Enforcement (includes Espionage, Homeland Security, Terrorism)
Leadership and Career Development
Literature, Poetry and Writing
Nonprofit Organizations and Charities (includes Fundraising)
Public Policy and the Law
Real Estate
Safety (includes Driving)
Science, Technology, Engineering, and Math (includes Computers and Computing, Email, Internet, IT Security, Statistics, Systems and Systems Development, Technology Transfer)
Washington Metropolitan Regional Issues

21. A/V (check all that apply)

Flip Chart
Internet Access
LCD Projector
TV and VCR
White Board and Markers


Mason Speakers Coordinator:
Sarah Gallagher
703.993.8761 Phone
703.993.3614 Fax

For problems related to this site, please contact the Webmaster
Last revised: January 29, 2013