Diversity Awareness Workshop Participant Application

2- Day Diversity Awareness Workshop Participant Application

Wednesday, June 17 and Thursday, June 18 2020

Priority will be given to Participant Applications that are received by Friday, May 1, 2020 to be considered.

Admitted applicants will be emailed to confirm attendance.

Participant’s Name *

Job Title *

Telephone *

Email *

Years of Service at UC Merced *

Why are you interested in this training? *

Campus Involvement (List committees, activities, etc.) *

How do you hope to use what you learn in the training to improve campus climate? *

FOR CREDIT COMPLETION, YOU MUST ATTEND BOTH FULL DAY WORKSHOPS. *

I AM AVAILABLE TO PARTICIPATE IN THE TRAINING FROM 8:15 AM-5:00PM on June 17 and 18, 2020.

I WOULD LIKE TO PARTICIPATE AT A FUTURE DATE.

Supervisor’s Name *

Supervisor's Job Title *

Supervisor's Department *

Supervisor's Telephone *

Supervisor's Email *

Supervisor’s Approval: Checking this box indicates you received supervisory approval to attend the two-day training.

I received my supervisor's approval to attend this workshop.

Date you received supervisor's approval

Lunch is provided if selected to participate. Please list any dietary restrictions.

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