Diversity Workshop Request Form

Please complete the following form to request a diversity workshop. When your request is received, you will be contacted and receive written confirmation. Please submit your request two weeks in advance. If you have any questions, please contact Mr. Seth A. Thompson at 844-8222 Ext. 4358 or via e-mail at: thompss@tc3.edu or visit Room 187.

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* 1. Date

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* 2. Name

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* 3. Organization

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* 4. Position

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* 5. Email

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* 6. Campus Address

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* 7. Phone

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* 8. Fax

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* 9. Who are the Participants? (Example: Residence Hall Program, Freshman Seminar, English 101, Student Organization, etc.)

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* 10. Information on Requested Workshop

Possible Date(s)

Time

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* 11. Workshops: (please check one)

Dimensions of Diversity

Gender Bread House

Identity Building

NCBI: Controversial Issues

NCBI: Diversity and Others

NCBI: Diversity and Self

Opening the Door on Homosexuality

Racism Y2K

Stereotype Challenge

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* 12. Location:

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* 13. Approximate number of particpants:

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* 14. Is Audio/Visual equipment available, if so what type: (DVD, VCR, Overhead, or etc.)

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* 15. Who will the presenter be greeted by?

*PLEASE NOTE: We will notify you one-week in advance with the names of your workshop presenter(s). Our turn around time to respond to request is one (1) week. If you do not hear from us within that time frame, please feel free to contact us via email or phone...