Diversity Presentation Request - Student Affairs Diversity Committee

The Student Affairs Diversity Committee offers presentations upon request for Student Affairs offices, and some student groups and outside organizations to help people learn about issues of diversity in a safe environment. The presentations we offer are a series of modules to help people understand and process content around diversity and social justice. As such, we need 2 hours to present each module you request. Please plan accordingly.

Please provide the following information so that we may process your request and schedule your presentation. All requests must be submitted one month prior to the date of the intended program, and are subject to the Student Affairs Diversity Committee discretion.

Contact Information

First Name

Last Name

Department or Organization

If Student Organization, please name organization.

If Outside Community Member, please indicate community group, position, or title

If Other, please indicate group, position or title.

Phone

(xxx-xxx-xxxx)

Presentation/Workshop Information

Which diversity module are you requesting?

Module 1 - Exploring Self & OthersModule 2 - Exploring Power, Bias, & ValuesModule 3 - Putting It All Together: Diagloging About Social JusticeOther

If Other, please indicate other module name.

Reason for Request

Goals for this Training

Preferred Dates and Times

Please indicate the dates and times you would like training. We will make every effort to accommodate your first choice. Dates must be at least one month in advance.

First Choice Date

(MM/DD/YYYY)

First Choice Time Range

00:00 AM/PM

Second Choice Date

(MM/DD/YYYY)

Second Choice Time Range

00:00 AM/PM

Third Choice Date

(MM/DD/YYYY)

Third Choice Time Range

00:00 AM/PM

Number of participants expected

Building and room number where the training will be held

Additional information