Training Request Form Posted on March 27, 2017March 27, 2017 by Veeraj Modi Step 1 of 3 33% Requester's Name*Department/Office/Organization*Course Name/Number (if applicable)*If this is not applicable, enter N/A.Course Section*If this is not applicable, enter N/A.Instructor and/or Organizational Leader(s)*Phone*Please use this format: (xxx)xxx-xxxBest time to be reached (via phone)*Email* Enter Email Confirm Email Proposed Presentation Topic*Creating CommunityBeyond DiversityPresentation descriptions are at the top of the pageDate (1st preference)* All proposed dates are contingent upon trainer availability and at the discretion of ODIME.Time* : HH MM AM PM Date (2nd preference)* All proposed dates are contingent upon trainer availability and at the discretion of ODIME.Time* : HH MM AM PM Length of Presentation*There is a 60 minute minimum for all workshops, except for academic class periods that are only 50 minutes (ex. 1hr, 80mins, 1hr 30mins, etc.)Location of PresentationDoes the location have a projector*YesNoDoes the location have a computer?*YesNoWhat prep work will you do, prior to ODIME coming, to prepare your students/participants for this session?*(e.g. engage in discourse about power and privilege, discuss identity development, identify "safe spaces" at Mason, etc.) Description of Participants*(e.g., age range, interest, experience level with issues/concepts of diversity and multicultural issues, etc.)Estimated Number of Participants*Learning Outcomes*What do you want/expect participants to be able to understand, communicate, and/or demonstrate as a result of this session? (e.g. Participants will have a better understanding of class and color privilege; participants will think critically about what they see and hear, etc.)How will you incorporate elements of this session into (a) your classroom practice; (b) your curriculum; (c) your office professional development plan, etc. over the course of the rest of the semester?*NameThis field is for validation purposes and should be left unchanged.