Consultation or Workshop Request Form - Center for Leadership

Consultation or Workshop request form

This request form is intended to centralize student, faculty, and staff leadership requests. Please complete the form if you are interested in arranging a workshop or consulting session for yourself or your group, club, organization, or department. A member of the Center for Leadership will be in touch with you after your request is submitted.

By partnering with the Center for Leadership for consultation services, you agree to keep Center for Leadership staff informed of the event planning and facilitation so that the workshop or event is a collaborative effort.

Requestor Information

Name *

Email Address *

Phone Number

Student group/organization/department

(if applicable)

Today's date/date request is submitted *

Month

Day

Year

Training Specifics

If you are requesting a workshop, group discussion, or formal presentation/event, please identify at least one leadership topic for us to cover in the presentation:

Topic *

Intrapersonal Development *

Interpersonal Development *

Cultural Competency/Understanding *

*For more information about the Center for Leadership’s Learning Domains and Leadership Competencies, please look at the document titled “Learning Domains and Competency Overview” or visit the “About” section of our website.

Preferred Date (please allow at least two weeks from today’s date): *

Month

Day

Year

Estimated Attendance (number of people): *

Estimated Duration (number of hours): *

Time of day for requested facilitation *

Hour

Minute

What are your goals for the session? What do you hope to get out of it? *

Additional notes/considerations:

Preparation

If you are requesting a workshop, presentation, or discussion, your club/group/organization/department will be responsible for several logistical aspects. Please read the below statements and check the appropriate boxes.

Acknowledgement *

I acknowledge that my club, organization, group, or department is responsible for booking (possible a smart room or a room with projector and screen capabilities if needed).

How did you hear about the Center for Leadership? *

Other

If you have any additional questions or concerns about this process, feel free to contact the Center for Leadership staff at leadership@calpoly.edu.

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Requestor Information

Training Specifics

Preparation

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