Scheduling Request Form

Welcome to the Scheduling Request form for Maryland Department of Aging Secretary Carmel Roques. Please use this form to submit the following types of scheduling requests:

  • Request for the Secretary to speak or present at an event
  • Request for the Secretary to attend an event
  • Request for the Secretary to meet with you or members of your organization
  • Request for the Secretary to visit a facility, organization, place of worship, etc.
  • Request for another member of MDOA to participate in an event

Notes:

  • Our office strives to provide a scheduling decision within 14 days of receiving a scheduling request. A member of our scheduling team will contact you with a response as soon as possible.
  • For scheduling requests that are received more than 6 months in advance of the event date, our team will follow up closer to the date.
  • Please do not submit a duplicate request if you have not yet received a response. Our team will provide you with a response as soon as possible. 
  • Requests for a visit at an unspecified time will be addressed as the Secretary's schedule allows.
  • If your scheduling request is approved, we ask that you do not announce the participation of the  Secretary or use her name on any materials (invitations, agendas, promotional materials, etc.) without the written permission of the Maryland Department of Aging.

Your request is sincerely appreciated, but due to the enormous volume of requests we receive, we will not be able to accommodate all submitted requests. Thank you for your patience as we review your scheduling request.

For any questions or concerns, email Christ Arrington at christina.arrington@maryland.gov.

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Requester Information
Please provide your name, contact information, and any relevant affiliations or identification information to facilitate the processing of your request.
Requester Name *
Requester Email *
Requester Phone Number *
Name of Organization *
Type of Organization *
Please specify whether the organization is a corporation, non-profit, educational institution, government agency, or other relevant categorization.
Point of Contact Name
Only enter if point of contact is different from requestor.
Point of Contact Title
Only enter if point of contact is different from requestor.
Point of Contact Email
Only enter if point of contact is different from requestor.
Point of Contact Phone Number
Only enter if point of contact is different from requestor.
Event Details
Please furnish details such as event name, date, time, location, purpose, expected attendance, and any additional pertinent information essential for planning and coordination purposes.
Event Type *
Please specify whether the event is a conference, seminar, workshop, training session, networking event, fundraiser, or another appropriate categorization to aid in understanding its format and objectives.
Name of Event? *
Please enter the designated name by which the event will be recognized and promoted, ensuring clarity and relevance to its purpose and theme.
Date of Event *
MM
/
DD
/
YYYY
Event start time *
Time
:
Event end time *
Time
:
Event location? *
Please provide the complete address, including street address, city, state or province, postal or ZIP code, and any additional location details, such as building name or room number, if applicable.
Parking Availability? *
Please indicate whether parking will be available on-site for attendees. Provide details about parking options, such as on-site parking lots, street parking availability, parking fees (if any), and any relevant parking instructions or restrictions.
Required
Purpose of the Event
 *
Please provide a clear and concise description of why the event is being organized, including its intended outcomes, audience size, and any specific themes or topics to be addressed.
Goal of Event
 *
Please articulate the desired outcomes you aim to achieve, such as educating the audience on a specific topic, inspiring action, generating discussion, or fostering understanding.
Audience Size
 *
Please provide an estimate of the expected number of attendees for the presentation.
Is the event open to the public? *
Please specify whether the event is open for attendance by the general public or if it is restricted to a specific audience, such as registered participants, members of a particular organization, or invited guests only.
Is the event open to the media? *
Please indicate whether you are extending invitations to media representatives or if there are any specific arrangements in place for media coverage, such as press passes, media registration, or designated media areas.
Anticipated Media Attendants
Please provide the names of specific newspapers, magazines, television stations, radio stations, online publications, or other media platforms that you anticipate may be interested in attending or reporting on the event.  (Name, title, news outlet).
Food and Refreshments *
Please indicate whether meals, snacks, or refreshments will be served.
Other Confirmed Speakers  *
Please include the names, affiliations, and topics of presentation for each additional speaker.
List any elected officials or other noteworthy attendees *
Please provide the names, titles, affiliations, and roles of each VIP or dignitary.
Paste agenda / schedule for the event below
 *
Please paste the agenda or schedule for the event in the space provided below. If you do not have an agenda available at this time, please type 'N/A', and we will be in contact with you shortly.
Speaker Information
Who is being requested to attend? *
Please select one or more MDOA staff to be in attendance.
Required
If the Secretary is unable to attend, please identify another departmental official you would like to represent the Secretary in her absence.
Biography Request *
Please specify if biographies or CVs are required for speakers, presenters, or other key individuals.
Presentation
Please provide details such as presentation title, description, duration, preferred format, technical requirements, and any additional instructions or materials necessary for the successful delivery of the presentation.
Presentation Topic *
Please provide a concise topic or description that encapsulates the focus of your event, ensuring clarity and relevance to the audience. 
Target Audience?
 *
Please provide information about the demographic, professional background, interests, or any other relevant characteristics of the audience you aim to engage with during your presentation.
Duration of the Presentation
 *

Total length of time allocated for the Maryland Department of Aging's segment of the event.

Will there be a Q&A session after the presentation?
 *

Please indicate if a designated Q&A session is planned as part of the event agenda, including details such as the duration of the session and any guidelines for participant interaction.

Will the event provide a podium or lectern for the speaker? *
Please indicate if there will be a designated speaking area equipped with a podium or lectern.
Is there a preferred method for sharing presentation materials in advance?
 *
Please specify if there is a preferred file format (e.g., PowerPoint, PDF) or online platform for sharing presentation materials, as well as any deadlines or submission guidelines that speakers should follow.
Will there be any photography, videography, or recording of the event? *
Please indicate if event organizers plan to capture visual or audiovisual content for documentation, promotional purposes, or archival purposes.
If Yes, Please provide photographer / videographer contact information
In the event that photography, videography, or recording services will be provided by external professionals, please furnish the contact details of the designated photographer or videographer. This may include their name, company or agency name, email address, phone number, and any other relevant information for coordination purposes.

If multiple photographers or videographers will be involved, please provide contact information for each individual or specify a primary point of contact for inquiries and scheduling.
Audio/Visual Equipment
Please specify the required equipment, such as microphones, speakers, projectors, screens, laptops, and any other AV accessories necessary for presentations, performances, or multimedia displays.
Presentation Equipment
 *
Please indicate whether the event venue is equipped with a projector and screen that speakers can utilize for their presentations.
Audio Equipment
 *
Please specify the type of microphones utilized for audio amplification during the event.
Presentation Advancement
 *
Please indicate whether you will have a clicker or remote presenter available for advancing slides during presentations.
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