* 1. Name

* 2. Email Address

* 3. Phone Number

* 4. Course Name(s) (i.e. WGST 200)

* 5. Number of Students in (each) Class

* 6. Building and Room Number(s)

* 7. Date (or dates) of presentation:

* 8. Start/End Time of Class(es)

* 9. Are there particular topics on which you would like us to present during the session?

* 10. Have you covered any sexual orientation and/or gender identity related content in class?

* 11. Are there any situations of which you are aware that we will need to take into account? (Such as someone who is LGBT and not out, or someone who is sensitive/aggressive with sexual orientation or gender issues)

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