EmailMeForm
DIS Workshop Registration
Diversity, Inclusion and Sensitivity Workshop
Saturday, March 18th, 2017
Hosted by The Council of Graduate Students
Name
*
First
Last
Email
*
Preferred Name
Preferred Pronouns
College
*
Please select
Agriculture and Natural Resources
Arts and Letters
Communication Arts and Sciences
Education
Eli Broad Graduate School of Management
Engineering
Human Medicine
Law
Music
Natural Science
Nursing
Osteopathic Medicine
Social Science
Veterinary Medicine
Other
N/A
Department
*
Put N/A if non student
College Level
*
Please Select
Undergraduate Student
Masters Student
Doctoral Student
Professional Student
Faculty/Staff
N/A
Year in Program
*
1st Year Grad
2nd Year Grad
3rd Year Grad
4th Year Grad
Dissertation
Freshman
Sophomore
Junior
Senior
N/A
(select one)
How did you learn about this event?
*
Flyer (paper)
Facebook
Twitter
Email
Friend
Other (list below)
(select one)
Other
Do you know someone who may be interested in attending the workshop with you? Provide us with their email and we'll send them an invite.
Please only provide their email if you feel comfortable sharing their email address.
General Questions
Optional
Please indicate your age group
Please select
18-24
25-34
35-44
45-54
55 or Above
Prefer Not to Answer
What is your gender identity?
Please select
Man
Woman
Transgender
I identify with a gender that is not listed
Rather not say.
Please specify your race or ethnicity
Please select
White
Black or African American
Native American or American Indian
Asian or Pacific Islander
Latino/a-Hispanic
Multiracial or Multiethnic
Rather not say.
Other (please list below)
Other
Room capacity is 150 occupants. Please complete preregistration and encourage others to complete preregistration to ensure attendance.
New this year: We will be incentivizing attendance - those who attend will have the chance to win raffle prizes before dismissal.
