CDI Training Request Form

Name: *

Email: *

Institutional Role or Affiliation: *

Student

Staff

Other

Organization/Department/Group: *

Number of Attendees Expected:

Small: 5-10

Medium: 11-25

Large: 26-50

Presentation: 51-100

Location:

On campus

Zoom

Please include the building and room number:
(The requester is responsible for securing a room for this training.)

Is this room accessible to students with varying needs?
(Ex: Is this room accessible by an elevator? Is there a microphone available?)

Yes

No (Please consider an alternate location where varying needs may be able to be accommodated.)

Unsure (Please check the room set-up prior to your meeting with a CDI Staff member.)

Does the room have A/V? This is preferred for presentation needs, but not absolutely required.

Yes

Unsure (Please check the room set-up prior to your meeting with a CDI staff member.)

Preference

Daytime

Nighttime (limited to staff availability).

Weekend (limited to staff availability).

Date - First Choice *

Start Time - First Choice:
All training and workshop sessions require at least 1.5 hours. *

Date - Second Choice (in case the first date is unavailable)

Start Time - Second Choice

Will this training be part of an on-going learning series?
(Ex: Retreat, staff meeting, exec board meeting, etc.) *

Yes

Please describe the participant population: *

Undergraduate Students

Graduate Students

Community Members

Training Offerings *

Managing Unconscious Bias and Inclusive Recruitment

Dialogue Overview and Group Activity

Topic not listed: Topic not listed:

Describe the primary goals and learning outcomes you wish to accomplish as a result of this training: *

Describe the group’s experience with this topic: *

Any additional information that would be helpful for us to know: