iTeam Request Form

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iTeam Request Form

Please complete this form to request an Inclusion & Diversity Education Team (iTeam) program, activity, or workshop. We are currently accepting requests for September 17-November 30, 2018. Please be as detailed as possible in your request. All requests must be submitted 2 weeks in advance of desired program date. Please contact the Center for Inclusion & Cross Cultural Engagement at inclusion@olemiss.edu or 662-915-1689 if you have any questions.

NOTE: iTeam is unable to accept any requests prior to September 17th or after November 30th.

First Name *

Last Name *

Email Address *

Phone Number *

Department/Organization Name/Course Name *

Desired Date of Program *

YYYY

Desired Program Start Time *

Time

Desired Program End Time *

Time

Program Location *

On campus building & Room Number

Estimated Number of Participants *

What are your intended outcomes? *

Please explain what you are hoping to gain. Describe the type of activities and discussion you would like the iTeam to facilitate.

Is there any additional information iTeam should know about your group or program request?

Include any special needs, challenges, etc.

Submit

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