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UW-Madison - Impact Small Group Facilitator Registration Form
The University of Wisconsin - Madison Fraternity & Sorority Life is hosting IMPACT the weekend of
February
24-26 at Perlstein Retreat Center by the
Wisconsin
Dells. We are looking for 12-16 higher ed professionals to serve as small group facilitators that will be able to have
difficult conversations, while still maintaining a positive attitude helping to move our community forward.
All facilitators travel will be covered based on travel needs along with
necessary
materials, lodging, meals, and apparel.
All facilitators are excepted to at the site at 9am to beginning training for the weekend.
Click here our IMPACT website for more information!
Additional
information will be sent out
once
facilitator
selection
has been made.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Pronouns
*
Your answer
Email
*
Your answer
Phone number
*
Please don't list your office phone.
Your answer
What institution/organization do you currently work for?
*
Your answer
Current Role/Position
*
Your answer
What is your sorority or fraternity affiliation?
*
If you are not affiliated to any sorority or fraternity, please put an N/A
Your answer
How would you best describe yourself?
*
Asian/Pacific Islander/Desi American
Black or African American
Hispanic/Latino/Mexican
Indigenous/Native
White
Biracial
Multiracial
Other:
If you selected other, please list how you best described yourself.
Your answer
I am first-generation college graduate.
*
A first-generations graduate is
one who is the first in their immediate family to attend and graduated from a four-year institution
Yes
No
Other:
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