Please fill in a valid value for all required fields
Please ensure all values are in a proper format.
Are you sure you want to leave this form and resume later?
Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.
Save and Resume Later
Save and get link
You must upload one of the following file types for the selected field:
There was an error displaying the form. Please copy and paste the embed code again.
Apply Discount
You saved
with code
Submit Form
Submitting
Validating
There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.
Please check the field:
Fields
Cal Poly Pomona Department/Organization
*
Contact Person
*
First Name
*
Last Name
*
Contact Phone
*
Contact Email
*
1st Choice Date/Time
*
https://cpp.formstack.com/forms/images/2/calendar.png
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
Hour
01
02
03
04
05
06
07
08
09
10
11
12
Minute
:
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM/PM
AM
PM
2nd Choice Date/Time
*
https://cpp.formstack.com/forms/images/2/calendar.png
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
Hour
01
02
03
04
05
06
07
08
09
10
11
12
Minute
:
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM/PM
AM
PM
3rd Choice Date/Time - Copy
https://cpp.formstack.com/forms/images/2/calendar.png
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
Hour
01
02
03
04
05
06
07
08
09
10
11
12
Minute
:
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM/PM
AM
PM
Length of Outreach (in hrs)
*
Location of Outreach
*
Number of Attendees Expected
*
Intended Audience
*
Students
Faculty
Staff
Others
Select an Outreach Topic
*
Office of Student Life and Cultural Centers (OSLCC) Tabling
Office of Student Life and Cultural Centers (OSLCC) 101
Building Common Ground (1 hour)
Microaggressions and Cultural Appropriation (1 hour)
Historical and Current Climate for Diverse Student Populations (1.5 hours)
Gender Identity, Sexual Identity, and Gender Expression Awareness (1.5 hours)
Power, Privilege, and Accomplices vs. Allyship (1.5 hours)
Exploring Your Social Identities (1.5 hours)
Inclusive Communication (1 hour)
Other:
Other Value
Please see workshop descriptions at https://www.cpp.edu/oslcc/oslcc-outreach/workshops.shtml
Please list at least 2-3 learning outcomes for your intended audience
*
What do you want your audience to learn from this workshop, presentation, or outreach?
Any additional comments
Previous
←
Next
→
Enter your save and resume password
Cancel
Confirm