Training Request Form

Requester's Name*
Department/Office/Organization*
Instructor and/or Organizational Leader(s)*
Course Name/Number/Section (if applicable)*

If this is not applicable, enter N/A.
Email*
Enter Email Confirm Email
Phone*
Please use this format: (xxx)xxx-xxx

Proposed Presentation Topic*
- Creating Community
- Beyond Diversity
- The Intercultural Development Inventory (IDI)
Length of Presentation*

There is a 60 minute minimum for all workshops (e.g. 1hr 30min)
Date (1st preference)*
MM slash DD slash YYYY

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

: Hours

Minutes

AM/PM
Date (2nd preference)*
MM slash DD slash YYYY

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

:

AM/PM
Location of Presentation*
Does the location have a computer?*
- Yes
- No
Does the location have a projector*
- Yes
- No
Special Requests*
(If you plan to facilitate your own workshop, please note so here.)
What prep work will you do, prior to CCEE coming, to prepare your students/participants for this session?*
(e.g. engage in discourse about power and privilege, discuss identity development, identify "safe spaces" at Mason, etc.)