Training Request Form – Coalition Building and Diversity Education

Requestor's Name*
Department/Office/Organization*
Instructor/Organizational Leader*
Course Name, Number, and Section
(If Applicable)
Email*
Enter Email Confirm Email
Phone*
Presentation Topic*
Date (1st preference)*
Date Format: MM slash DD slash YYYY

All proposed dates are contingent upon trainer availability and at the discretion of CBDE.
Time

: HH

MM
Date (2nd preference)*
Date Format: MM slash DD slash YYYY

All proposed dates are contingent upon trainer availability and at the discretion of CBDE.
Time*

: HH

MM
Presentation Location*
Does the location have a projector?*
Presentation Length*
There is a 60 minute minimum for all workshops (e.g. 1hr 30min)
Estimated Number of Participants*
Description of Participants*
(e.g. age range, interests, experience level with issues/concepts of diversity and multicultural topics, etc.)
What prep work will you do, prior to CBDE coming, to prepare your students/participants for this session?*
(e.g. engage is discourse about power and privilege)
Learning Outcomes*
What do you want/expect from participants to be able to understand, communicate, and/or demonstrate as a result of this session? (e.g. Participants will have a better understanding of class and color privilege; participants will think critically about what they see and hear, etc.)
Any Special Instructions?
If you plan to facilitate your own workshop, please note so here.