Feb 9, 2012 62°F/17°C
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DIVERSITY & EQUITY > Safe Space > Workshops > Registration Form Student & Campus Life

Safe Space Registration Form

In order for us to prepare for the training session, please provide us with the following information. The information will be used for tracking purposes only.

Affiliation with Chapman University:	Faculty Staff RA Student Greek Other:
Students are asked to complete section "A" of this form. (Please note: Students who are also staff or faculty are asked to complete section "B" of this form.)
A. Student:
List your Campus involvement:
Name:
ID Number:
Major:
Class:	First Year Sophomore Junior Senior Graduate
E-mail:
B. Staff and Faculty members:
Name:
Department:
Building:
Office Phone:
E-mail:


EVERYONE completes:
How did you hear about Safe Space Program?
What do you expect to gain from this workshop?
Please provide us with one question you would like answered or information you would like addressed:
Rate your knowledge of the LGBTQIA communities:	(1 = no knowledge ...5 = very knowledgeable)
Please check one in each category:
Gender:	Man Woman Transgender Gender Variant GenderQueer Other: No Response
Sexual Orientation:	Heterosexual Lesbian Gay Bisexual Queer Questioning Pansexual Other: No Response
Race/Ethnicity:	African American/Black Asian American/Pacific Islander/South Asian Caucasian/White American Indian/Indigenous/First Nations Hispanic/Latino@/Chican@ Bi-/Multi-racial Other: No Response
Workshop I would like to attend:	GREEK LIFE LGBT 101 Mon. Feb. 13 5:30-7:00pm GREEK LIFE LGBT 101 Mon. Feb. 20 5:30-7:00pm SAFE SPACE TRAINING Wed. Feb. 22 2:00pm-4:30pm SAFE SPACE TRAIN THE TRAINERS Mon. Feb. 27 & Tues. Feb. 28, both days required 9:00am-12:00pm, Safe Space Training pre-requisite. GREEK LIFE LGBT 101Tues. Mar. 13 4:40-5:00pm FACULTY/STAFF SAFE SPACE TRAINING Wed. Mar. 21 2:00pm-4:30pm FACULTY/STAFF SAFE SPACE TRAINING Fri. Mar. 23 9:00-11:30am SAFE SPACE TRAINING Thurs. Apr. 12 4:00pm-6:30pm

You will be e-mailed your confirmation for your preferred workshop once it is received by an administrator
Space is limited and training sessions will be filled on a first-come, first-served basis.
For more information or for accomodations, please contact Safe Space at safespace@chapman.edu