1. Choose a training date:

Other:

2. Complete the following information:

Print Name:   
Z#   
Academic College:   
Major:   
Are you currently enrolled this semester?    Yes No
FAU E-mail   
Local Mailing Address:   
Daytime Phone   
Evening/Alt. Phone   
Race:   
Ethnicity:   
Nationality:   
Cultural Heritage:   
Age/Age Group:   
Gender:   
Marital Status:   
Disability:   
Faith/Religion:   
Other background /self-identification information you would like to share:

How did you find out about the Diversity Training Program?

3. Verify and agree to the following:

Enrollment Policy : I am a currently enrolled FAU student, and agree to attend the entire training session from 8:30 a.m. to 5 p.m. on the Boca Raton Campus. I understand enrollment is limited to 25 students per session and is made on a first-come, first-served basis.

Cancellation Policy : I understand that cancellations must be made in writing and faxed or postmarked at least three business days prior to the training.

Signed: Date: