2020-2021 Diversity Awareness Workshops - Participant Interest Form

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Thank you for your interest in the Office of Campus Community Relations' Diversity Awareness Workshops. Please complete this form by October 16, 2020 in order to be fully considered for this year's sessions.

Notifications will be sent out in mid-October and selected participants will be assigned to one of the workshop dates according to their availability. Unfortunately we are unable to accommodate requests to change workshop assignments after they have been made.

If we are unable to accommodate you in this cycle, or if you are unavailable during this year's workshop dates, you will have priority selection for our upcoming sessions. We will contact you regarding future workshops as information becomes available.

Participant's last name *

Participant's first name *

Participant's campus affiliation *

Staff

Faculty

Student

Other:

For staff: Do you hold a manager or supervisor title? *

I am not staff

Yes

Participant's department (please no abbreviations) *

Participant's title *

Participant's email *

Participant's telephone *

Have you previously participated in the Diversity Awareness Workshop? *

Yes

I don't know

Were you previously waitlisted for a past workshop session? *

Yes

I don't know

Please check all of the following according to your availability: *

I am available to participate in the November 16 & 17, 2020 session

I am available to participate in the January 14 & 15, 2021 session

I am available to participate in the March 22 & 23, 2021 session

I am available to participate in the June 23 & 24, 2021 session

I would like to participate but I cannot attend any of these dates

Required

Dietary restrictions

Special needs/requested accommodations

Supervisor's name *

Supervisor's department (please no abbreviations) *

Supervisor's email *

Supervisor's telephone *

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