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
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) *
Your answer
Is the meeting confidential? *
Meeting request with: *
First Name *
Your answer
Last Name *
Your answer
M Number (i.e. M000..) *
Your answer
Phone Number (preferably cell phone) *
Your answer
MSU Email Address ( *
Your answer
Classification (I am a ...) *
Requested Date (i.e. 02-12-13) *
Your answer
Requested Time (i.e. 1:00 PM) *
Your answer
Please check the applicable description and fill out the remaining questions with additional details: *
Student Comments: *
Your answer
Meeting Notes (For Office Use Only)
Your answer
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