MSL Diversity Educators Facilitation Request 2019-2020

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Complete this form to request an MSL Diversity Educators facilitation. Please be as detailed as possible in your request. All requests must be submitted ONE MONTH in advance of desired program date.

First Name *

Last Name *

Email Address *

Phone Number *

Department/Organization Name/Course Name *

Desired Date of Program *

YYYY

Desired Facilitation Start Time *

Time

Desired Facilitation End Time *

Time

I must receive a confirmation email by (if your syllabus or schedule is dependent on a timely response from DE):

YYYY

Desired Location *

On campus building & room number

Estimated Number of Participants *

Please select the level of facilitation you would like the MSL Diversity Educators to facilitate. *The Diversity Educator Facilitation Request Form will allow space for any specific content you would like to request as part of your facilitation. We will do our best to accommodate requests and reach out with any clarifying questions. * *

Beginner (50 or more minutes required): These facilitations are geared more towards individuals and groups that are at the introductory stages of talking about and having dialogue around diversity, equity, and inclusion. Most of these facilitations cover a broad range of identities and introduce concepts and definitions of privilege, oppression, and difference. These can be beneficial for groups that may still be at the beginning stages of forming relationships.

Intermediate: (75 or more minutes required): These facilitations are geared towards groups that have some experience discussing and having dialogue around diversity, equity, and inclusion. Ideally, groups that request intermediate level facilitations will have done some foundational work with identity development, recognizing both personal identities and group identities. These are especially helpful for groups that have already formed familiarity with one another.

Advanced: (90 or more minutes required):These facilitations are geared towards groups that have experience discussing and having dialogue around diversity, equity, and inclusion. Ideally, groups that request advanced level facilitations have done both personal and group identity development work. These can be groups that have requested a Diversity Educator facilitation in the past and want to deepen the dialogue or groups that have done this work on their own or with others on campus. These facilitations can also be ideal for groups of 50 or more people.

Required

Please provide what you would like for your group or students to gain from this activity? (In this description please include the topics surrounding diversity & inclusion that you would like for them to touch on) *

Be as descriptive as possible

Please provide the current set up of the room in which the Diversity Educator facilitation will take place. *

Be as descriptive as possible (chairs, tables, etc.)

Is there any specific topic, area, or concept you would the Diversity Educators to cover with your group? If yes- please explain in as much detail as necessary *

Include any group dynamics, special needs, challenges, etc.

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