iTeam Request Form
Please complete this form to request an Inclusion & Diversity Education Team (iTeam) program, activity, or workshop. We are currently accepting requests for September 18-December 1, 2017. Please be as detailed as possible in your request. All requests must be submitted 2 weeks in advance of desired program date. Please contact the Center for Inclusion & Cross Cultural Engagement at inclusion@olemiss.edu or 662-915-1689 if you have any questions.
First Name
Your answer
Last Name
Your answer
Email Address
Your answer
Phone Number
Your answer
Department/Organization Name/Course Name
Your answer
Desired Date of Program
MM
/
DD
/
YYYY
Desired Program Start Time
Time
:
Desired Program End Time
Time
:
Program Location
On campus building & Room Number
Your answer
Estimated Number of Participants
Your answer
What are your intended outcomes?
Please explain what you are hoping to gain. Describe the type of activities and discussion you would like the iTeam to facilitate.
Your answer
Is there any additional information iTeam should know about your group or program request?
Include any special needs, challenges, etc.
Your answer
Submit
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