MSL Diversity Educators Facilitation Request Form
Complete this form to request an MSL Diversity Educators facilitation. Please be as detailed as possible in your request. All requests must be submitted 2 weeks in advance of desired program date.
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 Facilitation Start Time *
Time
:
Desired Facilitation End Time *
Time
:
Desired Location *
On campus building & room number
Your answer
Estimated Number of Participants *
Your answer
Please select the activities you would like the MSL Diversity Educators to faciliate.
Please provide the MSL Diversity Educators with any information about your group that you believe would be helpful in preparing your facilitation. *
Include any group dynamics, special needs, challenges, etc.
Your answer
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