Media Interview Request Form - University of Arkansas at Pine Bluff

Thank you for your interest in conducting a media interview with Chancellor Anthony Graham, Ph.D.

Please complete the interview request form with as much detail as possible. The form must be submitted 72 hours prior to your requested interview date.

If this is an urgent request (less than 72 hours), please contact Stephanie Jackson at stephanie@designgroupmarketing.com.

* Denotes a required answer

REQUESTING ORGANIZATION INFORMATION

Organization Name(Required)

INTERVIEW INFORMATION

Interviewer’s First and Last Name(Required)

Interviewer’s Title(Required)

Date *(Required)

Time(Required)

Expected Length of Interview (select one) *(Required)

Platform Where Interview Will Exist (select one) *(Required)

Will the interview be recorded or live?(Required)

Provide the Intended Outcomes or Rationale of Interview(Required)

Describe the Expected Audience

Proposed Interview Questions

Will any photos or video be captured during the interview? *

Will any photos or video be captured during the interview?

Will any other individuals be interviewed or present? If yes, please also include names and titles.(Required)

Please use the space below to share any additional details that may assist us in reviewing your request. This may include background context, relevant links or materials, special considerations, or anything not previously addressed in the form.

File

Max. file size: 100 MB.

CONTACT INFORMATION

Contact Name(Required)

Contact Number *(Required)

Contact Email(Required)

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