JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
IGR Workshop/Training Request Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Hello from the Intergroup Relations Program! Please fill out the workshop/training request form below in order to help us understand how we can support you and your organization/department. Go Bruins!
Organization/Department name:
Your answer
Contact name:
Your answer
Contact phone number:
Your answer
I am requesting ___________ workshop/training(s): (you may choose more than one option)
Social Identities/Diversity Awareness
Dialogue Communication Skills
Micro-aggressions/Implicit Bias
Conflict Styles, Management, & Resolution
Dialogue Facilitation Training
I am interested in CONSULTATION to determine the best workshop topic.
If only seeking consultation, please list two different dates and times you would like to meet for consultation for the chosen topics:
Your answer
If seeking workshop/training, please list first priority request date (option 1):
MM
/
DD
/
YYYY
Workshop/training second priority request date (option 2):
MM
/
DD
/
YYYY
Predicted time of workshop/training:
Time
:
AM
PM
Anticipated # of Attendants
Your answer
Is this workshop/training for undergraduate students, graduate students, faculty, or staff? (you may choose more than one option)
Undergraduate
Graduate
Staff
Faculty
Other:
Briefly describe your organization/department's history:
Your answer
Briefly describe your organization/department's intergroup dynamics: (individual relationships with and amongst each other)
Your answer
Briefly describe your organization/department's main goals you wish to accomplish during this workshop/training/consultation:
Your answer
Has your organization/department ever been trained in diversity, implicit bias, or social identities? If so, when and by what entity?
Your answer
How did you hear about IGR? (you may choose more than one option)
IGR flier/pamphlet
IGR staff (e.g. IGR Peer Diversity Leader)
Bruin Resource Center
Social media (e.g. Facebook)
UCLA's Equity, Diversity, and Inclusion Office (E.D.I.)
Student Affairs Professionals
Other:
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Google Apps for UCLA.
Report Abuse
Forms
