Office of Civil Rights & Diversity Program Request

Office of Civil Rights & Diversity Program Request

Please complete the fields below with as much information as possible.

Name Name * First Last
Email *
Phone Phone - ### - ### ####
Department or Organization *
What type of program are you requesting? *
Who is the proposed audience? *
Number of Expected Attendees *
What is the proposed timeline for this program? *
Please provide proposed date and time options for consideration *
Location of Event
Please provide additional information/details regarding your event/program.