First Name :

Last Name :

Email address:

Class Name:

Course Number:

Estimated Attendance :

Date/Time of Presentation :

Alternative Date/Time of Presentation :

Class Duration:

Presentation Duration:

Provide a detailed description of the type of diversity/multicultural presentation you would like for your class. This will assist us in planning and tailoring the presentation to your needs.

Notes or Special Requests:

Once submitted, your request will be reviewed in a timely manner. Our staff will communicate with you about request approval and time availability.

If you have any questions about this form, please contact Kelvin Rodriguez, Assistant Director of Multicultural Affairs.