Please complete the following form to request a diversity workshop. When your request is received, you will be contacted and receive written confirmation. Please submit your request two weeks in advance. If you have any questions, please contact Mr. Seth A. Thompson at 844-8222 Ext. 4358 or via e-mail at: thompss@tc3.edu or visit Room 187.

Date

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* 1. Date

Name

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* 2. Name

Organization

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* 3. Organization

Position

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* 4. Position

Email

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* 5. Email

Campus Address

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* 6. Campus Address

Phone

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* 7. Phone

Fax

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* 8. Fax

Who are the Participants? (Example: Residence Hall Program, Freshman Seminar, English 101, Student Organization, etc.)

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* 9. Who are the Participants? (Example: Residence Hall Program, Freshman Seminar, English 101, Student Organization, etc.)

Information on Requested Workshop

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* 10. Information on Requested Workshop

Workshops: (please check one)

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* 11. Workshops: (please check one)

Location:

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* 12. Location:

Approximate number of particpants:

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* 13. Approximate number of particpants:

Is Audio/Visual equipment available, if so what type: (DVD, VCR, Overhead, or etc.)

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* 14. Is Audio/Visual equipment available, if so what type: (DVD, VCR, Overhead, or etc.)

Who will the presenter be greeted by?

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* 15. Who will the presenter be greeted by?

*PLEASE NOTE: We will notify you one-week in advance with the names of your workshop presenter(s). Our turn around time to respond to request is one (1) week. If you do not hear from us within that time frame, please feel free to contact us via email or phone...

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