Diversity Workshop Request Form
Form must be completed 30-days prior to presentation
Name
Your answer
Department or Division
(e.g. Office of Institutional Diversity)
Your answer
Email Address
Your answer
Phone Number
(please include area code)
Your answer
Preferred Presentation Date
MM
/
DD
/
YYYY
Preferred Start Time
Workshops generally last 1 hour
Time
:
Alternate Presentation Date
MM
/
DD
/
YYYY
Alternate Start Time
Time
:
Audience
Please provide a description of the purpose of your workshop request
Your answer
Submit
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