PRESENTATION/WORKSHOP REQUEST FORM

Please complete and submit the following form to request a diversity/multicultural presentation/workshop for a class or program, from the Office of Multicultural Student Affairs:

Name:
Phone Number:
E-Mail Address:
Class/Program:
Duration:	Minutes Hours Days
Number of Participants:
Date:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008 2009
Time:	: AM PM
Back-up Date:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008 2009
Back-up Time:	: AM PM
To assist in planning, please provide a brief description of the type of presentation/workshop requested.

We will review your request and get back to you about approval and time availability. For any further information, please contact Bernadette Tiapo, Director, Office of Multicultural Student Affairs, at 607–436–3353 or tiapobs@oneonta.edu.