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?*

Student
Faculty
Staff

Name of Class, Organization, Department*

Who is your target audience?*

Students
Faculty
Staff
Elon University Affiliate

Number of Participants*

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

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)

Please describe the nature of the consultation being requested.*

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

What type of workshop?*

Please describe the nature of the workshop being requested.*

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

Which bias education workshop?*

BE Aware
BE Accountable
BE Advocates

Allotted time for session*

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

Allotted time for session*

Desired Date (1st choice)*

Desired Time (1st choice)*

: HH

MM

Desired Date (2nd choice)*

Desired Time (2nd choice)*

: HH

MM

Location*