Division of Inclusion and Equity

Workshop Request

Choose Workshop: *

Requesting Department: *
Contact Person: *
Email: *
Phone: *  (XXX-XXX-XXXX)
Workshop Desired Date:
Desired Time:
Alternate Date:
Alternate Time:
Workshop Length: Hour(s)
Location: *
Description of audience: *
What do you hope to accomplish as a result of this workshop? *
Is there any additional information that should be considered when selecting your speaker or in preparing that speaker for the workshop?