Multicultural Affairs Committee

Member Information

(Please Print)

Date : __________________________

Name : _____________________________________________________________

Position/Title : _______________________________________________________

Division : __________________ Program : ________________________________

Supervisor : ____________________________

Office Mailing Address : ______________________________________________

Office Telephone : ____________________________________________________

Home Telephone : (Optional) __________________________________________

Special Interests/ Comments : __________________________________________

Please indicate your Committee interest:

Please mark at least ONE

Diversity Conference ______

Diversity Calendar _____

Promotion, Retention, Recruitment and Public Relations _____

Memberships, Food Festivals, Brown Bag Lunches _____

Planning and Implementation of Long Term Goals _____

Policy Review _____

Historical Archives _____

Return Completed membership to: Jeff Jaquess, DGLS