OMA Student Meeting Request Form
Dr. Marvin D. Mills Multicultural Center The Office of Multicultural Affairs 110 Curris Center Murray, KY 42071-3356 Phone: (270) 809-6836 Fax: (270) 809-3075 Email:
Please complete the entire form
This form is only viewed by OMA Professional Staff. All Confidential requests will be handled accordingly.
Date (i.e. 02-12-13)
Is the meeting confidential?
Meeting request with:
Student Services Specialist
M Number (i.e. M000..)
Phone Number (preferably cell phone)
MSU Email Address (@murraystate.edu)
Classification (I am a ...)
Requested Date (i.e. 02-12-13)
Requested Time (i.e. 1:00 PM)
Please check the applicable description and fill out the remaining questions with additional details:
Emerging Scholars Institute
Diversity Scholars Program
I'd rather not say
Meeting Notes (For Office Use Only)
Never submit passwords through Google Forms.
Terms of Service