Name:
*
Email:
*
Affiliation
Student
Staff
Other
Organization/Department/Group:
*
Group size:
Small: 5-10
Medium: 11-25
Large: 26-50
Presentation: 51-100
Location:
On campus
Zoom
Please include the building and room number: (The requester is responsible for securing a room for this training.)
Is this room accessible to those with varying needs?
Yes
Unsure (Please check the room set-up prior to your meeting with a CDI Staff member.)
No (please consider an alternate locations where varying needs may be accommodated)
Does the room have A/V? This is preferred for presentation needs bu not absolutely required)
Yes
No
Unsure (Please check the room set-up prior to your meeting with a CDI staff member.)
Preference for time of day
Daytime
Nighttime (limited to staff availability)
Weekend (limited to staff availability)
Date-First Choice
*
-
Month
-
Day
Year
Date
Start Time-First Choice (all workshop sessions require at least 1.5 hours)
Hour Minutes
AM
PM
AM/PM Option
Date-Second Choice (in case the first date is unavailable)
*
-
Month
-
Day
Year
Date
Start Time-Second Choice
Hour Minutes
AM
PM
AM/PM Option
Will this workshop be part of an ongoing learning series (Ex. retreat, staff meeting, exec board meeting)?
Yes
No
Please describe the participant population
Undergraduate Students
Graduate and/or Professional Students
Workshop offerings
Creating Strong Community Agreements for Your Group
Difficult Conversations in Action
Dialogue in the Classroom
Dialogic Leadership
Dialogue Circle - covering a current event or issue of your choosing (pending approval of DxD team)
Other
Describe the primary goals and learning outcomes you wish to accomplish as a result of this training:
*
Describe the group’s experience with this topic:
*
Any additional information that would be helpful for us to know:
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