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Safe Zone Workshop Request Form
Please fill out form completely. A Multicultural professional staff member will contact you shortly after submission.
Email address *
Georgia State affiliation *
Department/Student Group Requesting *
Your answer
Name of Requester *
Your answer
Position or Title of workshop requester *
Your answer
Preferred workshop location (i.e., Multicultural Center, departmental meeting room) *
Your answer
Preferred workshop date *
Preferred workshop time (*note, this is a 3 hour workshop) *
How many participants will be attending (*no more than 15 recommended) *
Your answer
A copy of your responses will be emailed to the address you provided.
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