City of Hampton, Unity Commission, Diversity College Registration

Diversity College Application

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Hampton Diversity College - Level III Hampton Diversity Facilitator Training Institute II Diversity Train-The-Trainer November 16, 17, 23 & 24, 2009
*Name:
Nickname:
*Address:
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*Daytime Phone:
*E-mail:
The following information is confidential and is requested only for the purpose of insuring that the class sessions are diverse.
*Job Title:	Department:
*Age:	Gender: Religion:
*How do you prefer to identify yourself racially?:
*Educational level achieved:
Indicate why you are interested in enrolling in the Hampton Diversity College:
What do you hope to gain or learn from participating in the Hampton Diversity College?:
Describe your involvement with other community and/or civic activities:
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