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Sexual Harassment Prevention Program Training Request Form

Contact Information

Contact Name:
Email:
Phone: 
Campus Unit:
Campus Address:
Dean, Director, Department Head:

Audience Demographics

Academic Status of Participants (Check all that apply)
Exempt Staff
Non-Exempt Staff
Faculty
Graduate Student
Undergraduate Student

Racial Categories of Participants (Please provide us with numbers)

African American/Black Asian/Asian American/Pacific Islander
Native American  European American/White
Latina/o Arab American
International  
Other
(if any of the above do not apply, please fill this out).		  

Number of Participants

Please indicate the number of persons attending this workshop. Please provide a breakdown by gender, if possible.
Total Participants:
 Males:
 Females:

Workshop Date and Time

Please list three workshop dates (MM/DD/YY) and times in order of priority. Please note that workshops for faculty, staff, and/or graduate students takes approximately two hours, while workshops for undergraduate students take approximately one hour.

1. Date: Time:
2. Date: Time:
3. Date: Time:

Location: (Please be SPECIFIC)

Background Questions / Comments

For what purpose(s) are you requesting this training? (Please explain)

Has the issue of sexual harassment ever been discussed with this group? (Please explain)

Has this group received a copy of the sexual harassment policy? (Please explain)

Comments:

NOTE: Do Not Alter These Fields:

Due to limited resources, we request that units receiving training prepare copies of the handout packet for all participants.

You may download the SHPP Training Packet here in a regular or large print format.

Your request will be submitted by email to the coordinator of the SHPP program. You will receive an email "receipt" within one working-day of submission.

Questions about the Sexual Harassment Prevention Program can be addressed to the Program Coordinator at bass@umd.edu.