Committee to Celebrate Diversity
Event Submission Form
Completed form must be received through this Web site or in hard copy by the 15th day of the month PRIOR to the event.
If submitting this form in hard copy, it must be typed & return to:
Committee to Celebrate Diversity
c/o Gina M. Vanacore, Chairperson
Associate Director of Residential Programs
Division of Campus Residences
Z-4444
631 632 6972
Saturday, 10/11/2008
11:22 PM EDT
Event
Diversity (Monthly):
Event Title:
Date:
Location:
Start Time:
End Time (Approximate):
Format of Event (Please check only one):
Lecture/Demonstration In Class by the Course Instructor (LIF)
Please provide name of instructor and class title:
Lecture/Demonstration Outside of Class by Faculty/Staff Members (LOF)
Please provide name of lecturer:
Lecture/Demonstration Outside of Class by Outside Presenter(s) (LOO)
Please provide name and credentials of guest presenter(s):
Lecture/Demonstration Outside of Class by a Student (LOS)
Interactive Presentation (discussion/workshop involving substantial audience participation). (IP)
Please provide name and credentials of presenter(s) and/or facilitator(s):
Performance/Exhibition (PEX)
Film (FI)
Provide title and a one-sentence description of the film, and from where rights to show film were obtained:
Food Sampler. Program primarily designed to provide food tasting and provision of other cultural information. (FS)
Variety. Program that involves one or more of the above listed formats. (VA)
Specific Purpose & Description of Event:
Target Audience:
Contact Information
Name of Primary Contact Person:
Campus Phone:
Email:
Campus Address:
Advisor's Name:
Campus Phone:
Email:
Campus Address:
Sponsor(s)
Names of groups providing support for the event:
If the event wins an award, which of these groups will share the award money?:
NOTE: Organizer's Event Evaluation Form and (if applicable) Supervisor's/Advisor's Event Evaluation Form must be received within 1 week after the event to be considered for an award.
Type in the characters you see above (case sensitive) to submit this form.