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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
MM
/
DD
/
YYYY
Preferred workshop time (*note, this is a 3 hour workshop)
Time
:
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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