M.O.S.A.I.C. & LGBTRC Participation Form (Staff, Faculty, and Community Members)

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Individuals who fill out the following form will be added to the MOSAIC and LGBT+ Resource Center Community newsletter. After completion, you will begin to receive updates on MOSAIC events and programs, and receive information on diversity focused events happening in the community.

First Name *

Last Name *

Title *

Department/Organization *

E-Mail Address *

The following questions are optional. This information is kept confidential and is used to develop programming and resources for the diverse communities we serve.

Phone number

Gender

Ethniciti(es)

Do you identify as LGBTQ+? (We often share resources through our LGBT+ Resource Center)

Are you a first generation college student? (The first in your family to attend/graduate college)

Yes

N/A

Clear selection

Is English your first language?

Yes

Clear selection

If no, please specify your first language:

Submit

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