ODEI: Diversity Workshop Request Form
Thank you for your interest in requesting a workshop for your team/department. The workshops are presented by the Office of Diversity, Equity, & Inclusion team at Georgetown School of Medicine. The following are topics you can request, but anything can be customizable. If you have a specific request, please email Dr. Susan Cheng, Sr. Associate Dean for Diversity, Equity, Inclusion at smc307@georgetown.edu

Sample topics:
Advancing Racial Justice, Advocacy, Allyship in the Workplace
Unpacking 4 I’s of Oppression
Defining Racism in American Medicine (What is non racist, racist, anti-racist and how to strengthen competencies around Anti-Racism)
Bystander Intervention: the 5 D's Method
Discussing Race & Holding Space for Sensitive Conversations
How to create a culture of Belonging and Inclusivity with Your Students & Learners in the Learning Environment
Safety in the Learning Environment: Responding to Bias and Microaggressions
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Full name (First and Last) *
Title *
Office/Department at Georgetown *
Preferred email (if using your Georgetown email, please include your netID in the email address). *
Best number to reach you
Role (please check all that are applicable) *
Required
Georgetown Affiliation *
Required
What workshop topic are you interested in requesting? (If you would like to inquire on a topic not listed below, please complete other section.) *
What are your preferred dates for training? Please list specific dates and preferred times. Please list out dates at least 3 weeks out from the date of submitting this form. *
What is your requested length of training? *
Required
Are you open to allowing attendees from outside your department to join your session? *
How many people (approximately) do you anticipate attending this training? *
Who is the audience for this training? *
I confirm that due to COVID-19, all requests for training will be for virtual training over zoom. *
Thank you for your interest. If you have any comments, questions or suggestions, you may leave them below:
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