DPE Session Request Form 2012 2013
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Diversity Peer Education Program - Session Request Form

 
Please use this form to request Diversity Peer Educators to facilitate a diversity program with your group.

Fill out all of the information to the best of your knowledge. Someone from the DPE program will contact you to confirm the logistics of the session.

If you have questions or concerns regarding your request, please contact Don Austin in OSEMA at 4-3222 or via email at austin@ithaca.edu
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1. Group Information
2. SELECT YOUR SESSION FROM ONE OF THE MENUS BELOW!
(For full descriptions, go here: http://www.ithaca.edu/sacl/osema/opportunities/dpe/)

*NOTE: Sessions will be added throughout the year*
Workshop SeriesFilm Series (All films currently available for presentation)
Session Selection
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3. If you are hosting a film presentation or Truth Trivia, you will need to provide a television and DVD player or computer, projector, and screen.
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4. Please select three potential dates and times to hold your program:
MM DD YYYY HH MMAM/PM
First (Best) Option
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Second Option
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Third Option
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5. If this session is in the evening, will you provide refreshments for the participants?
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6. How many participants do you anticipate will attend the session?
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7. Where on campus will this session be held? (NOTE: DPEs are *not* responsible for reserving the space for the session, that is the responsibility of the session host)
8. Do you have any additional questions regarding your request?
9. Please tell us how you intend to promote or advertise this opportunity to students: