M.O.S.A.I.C. & LGBTRC Participation Form (Students)
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.
Student ID
Your answer
First Name *
Your answer
Last Name *
Your answer
(UCCS) Email *
Your answer
Student Status
Major(s)
Your answer
Minor(s)
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
Date of Birth (We send out birthday wishes)
MM
/
DD
/
YYYY
Gender
Your answer
Ethniciti(es)
Your answer
Do you identify as LGBTQ+? (We often share resources through our LGBT+ Resource Center)
Are you a first generation college student? (First in your family to attend college)
Are you an international student?
Is English your first language?
If no, please specify your first language:
Your answer
Submit
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