Request for Services

Name*

Please use the name you prefer to be addressed by.

First Last

Pronouns

Email*

Provide your Elon email address (unless you are alumni or Elon University affiliate).

What is your role?*

Faculty
Student
Staff

Name of Class, Organization, Department*

Are you requesting a consultation or workshop?*

(Consultation: An individual or group advisory meeting with an Inclusive Excellence team member to develop ideas and best approaches to address inclusive excellence goals and objectives)

(Workshop: A group engagement opportunity facilitated by an Inclusive Excellence team member designed to increase knowledge and praxis of inclusive excellence concepts)

Who is your target audience?*

Number of Participants*

Facilitation may vary based on group size. Please be as accurate as possible.

Please describe the nature of the consultation being requested.*

What type of workshop?*

Informative Presentation
Inclusive Lens Workshop
Bias Education (BE) Workshop

Which bias education workshop?*

Please note: allow 1 hour for each workshop. Can be grouped as a series or stand alone workshops.

BE Aware: Microaggressions Matter
BE Aware: Unpacking Bias for Community Building
BE Accountable: Embracing Identities
BE Accountable: Exploring our Unique Identities
BE Advocates: Power, Privilege, and Positionality
Be Advocates: Developing Awareness and Advocating for Change

Delivery option:*

In-Person
Virtual

Please describe the nature of the workshop being requested.*

Please list the desired outcome(s) of the requested workshop.*

Allotted time for session*

Minimum allotted time is 60 min. for Inclusive Lens and Bias Education Workshops

Desired Date (1st choice)*

Desired Time (1st choice)*

: HH

MM

Desired Date (2nd choice)

Desired Time (2nd choice)

: HH

MM

Location (if in-person)