IML Engagement Form – Institute for Music Leadership

Date of Submission(Required)

Are you…(Required)

An Eastman faculty, staff or student recommending a guest

An individual/organization interested in engaging with the IML

Guest Interest & Speciality

How do you want to engage with the Institute for Music Leadership? What do you want to bring to our community?

I am interested in being… (select all that apply)(Required)

a guest speaker

a mentor for a student

an Eastman Case Study partner

a guest on the Podcast Careers in Crescendo

I am a(n)… (select all that apply)(Required)

Eastman Alum

Catherine Filene Shouse ALP Certificate Alum

MAML Alum

UofR Alum

None of the above

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Check Value 1(Required)

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Check Value 2(Required)

Please provide information about you and/or your organization.(Required)

Eastman Recommender Information

Please provide YOUR information

Recommender Name(Required)

First Last

Recommender Email(Required)

Guest Name(Required)

First Last

Do you have a connection with the person you are recommending?(Required)

Yes

No

Indirectly (i.e. Eastman alumni, colleague of a friend, etc.)

Why are you recommending this guest? What do you think they could bring to the Eastman community?(Required)

Guest Information (Individual or Group)

Please provide the GUEST information.

Guest Information (Individual or Group)

Please provide the GUEST (and/or if YOU are also the GUEST) information.

Prefix/Pronouns

Guest Name(Required)

First Last

Guest Email(Required)

Mailing Address (should our students want to send you a thank you note)

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

Guest Job Title or Role(Required)

Guest Affiliated Organization(Required)

Guest Website(Required)

Guest Biographical Information

Is there anything else you would like to add?