DPE Session Request Form 2013 2014

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 Darnell Thompson in Residential Life or via phone at (607) 274-1151 or email at dlthompson@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/)
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. Select three potential dates and times to hold your program:

We ask that you do NOT select dates that fall within 2 weeks of the day you are submitting this form:
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 program is in the evening, can you provide refreshments for the participants?
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6. How many participants do you anticipate will be in attendance?
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7. Where on campus will this program be held? Please include the residence hall floor, as well. (NOTE: DPEs are *not* responsible for reserving space for your session)
8. Please tell us how you intend to promote/advertise this opportunity:
9. Do you have any additional questions regarding your request?