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EDI Engagement & Resources Request Form
The Office for Equity, Diversity, and Inclusion (EDI) is committed to building student, staff, and faculty capacity to learn about diversity, build individual and departmental skills in addressing equity at the local level, and to move the campus forward in our strategic planning toward inclusive excellence and a more welcoming and supportive campus climate. Please complete this form as a starting place. In order for us to support you, we need to better understand your request.  

* Please note in many cases, training may not be the best solution to the issues raised.  A longer-term engagement/resources consultation or connecting with UC San Diego Human Resources Department may be needed. You will be assigned an EDI lead contact to assist you.

* Requests for participant accessibility and accommodations such as American Sign Language (ASL), closed captioning, mobility, and/or visual impairment may require additional support and the requestor will make the appropriate arrangements and cover these costs.

* NOTE: This form is a REQUEST ONLY, contingent upon approval, modification, and/or confirmation.


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Email *
Acknowledgment *
Required
1) Today's Date: *
MM
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DD
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YYYY
2) Requestor First/Last Name: *
3) Gender Pronouns:
4) Requestor's Unit/Department/Organization: *
5) Description or name of group requesting engagement and resources:
6) Phone Number (Area Code): *
7) Best day/s and time/s to contact you: *
8) Please describe the nature of the concerns that precipitated your outreach.  It is important for us to understand more background so that we can determine the best approach for you/r unit/department/organization:   *
9) Has your unit/department/organization done any previous work to address this issue or this area of concern? *
10) If you answered "Yes" to the question above, please describe:
11) In the past year, has your unit/organization/department participated/hosted an EDI-related engagement or consultation? *
12) If you answered "Yes," "Unsure," or "Other" to the question above, please explain:
13) Title/Theme of Engagement and Resources Requesting: *
14) Type of Request - Please check all that apply: *
Required
15) If you answered "Other" to the question above, please explain:
16) If you answered "Maybe" or "No" to the question above, please explain:
17) Would you be open to receiving a consultation on a more strategic and long-term approach to addressing your unit's or group's issues? *
18) If you answered "Maybe" or "No" to the question above, please explain:
19) Intended audience or group/s - Please check all that apply: *
Required
20) If you answered "Other" to the question above, please explain:
21) If applicable, number of participants or attendees: *
22) Proposed date/s and time/s of engagement or consultation - List 1st, 2nd, and 3rd choice: *
23) If applicable, time block you are requesting: *
24) Zoom Virtual Conference or Physical Location Logistics - NOTE: Public health and safety accommodations may impact feasibility of any in-person contact.
25) Information and logistics about Zoom engagement or reserved location - Please check all that apply: *
Required
26)  Accessibility and Accommodations Notes:  * Requests for participant accessibility and accommodations such as American Sign Language (ASL), closed captioning, mobility, and/or visual impairment may require additional support and the requestor will make the appropriate arrangements and cover these costs. *
27) Is this engagement for an audience or group that meets regularly? *
28) Would you like to share any additional information or context for this engagement request?
Thank you. Please note that over the summer, our EDI staff are taking much needed and deserved time off and therefore, it can take up to 4-5 weeks to meet on any training requests. Thank you for your understanding.
A copy of your responses will be emailed to the address you provided.
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