Diversity Education Request

About the Experience

All requests should be made at least four weeks in advance of the event date. Does the request meet this requirement? *

Yes, this request meets the requirement.

No, this request does not meet the requirement.

Topic(s) request *

Anticipated # of attendees *

Intended audience (specify % of students, faculty, staff, community members, etc.) *

Preferred date(s) and time of day *

Preferred time frame for experience *

Requestor

Name *

Pronoun (i.e. she, he, they, ze, etc)

E-mail *

Contact Number

Name of department, office, organization or group *

Other Information

Expected outcomes of the expereience *

Frequency of experience (select one)

One time

Multiple experiences

Is this the first diversity education experience for your organization or department? (select one)

Yes

Leave this field blank