M.O.S.A.I.C. & LGBTRC Participation Form (Staff, Faculty, and Community Members)
Individuals who fill out the following form will be added to the MOSAIC and LGBT+ Resource Center Community newsletter. After completion, you will begin to receive updates on MOSAIC events and programs, and receive information on diversity focused events happening in the community.
First Name
Your answer
Last Name
Your answer
Title
Your answer
Department/Organization
Your answer
E-Mail Address
Your answer
The following questions are optional. This information is kept confidential and is used to develop programming and resources for the diverse communities we serve.
Phone number
Your answer
Gender
Your answer
Ethniciti(es)
Your answer
Do you identify as LGBTQ+? (We often share resources through our LGBT+ Resource Center)
Your answer
Are you a first generation college student? (The first in your family to attend/graduate college)
Is English your first language?
If no, please specify your first language:
Your answer
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