Workshop Request Form

Please complete the following form to request an NCBI workshop for your office, unit, division, or other interested group.

Your Group Information
Requestor Last Name:
Requestor First Name:
I am:
Phone:
Email:
Department/Office/ Organization:
Group Name:
Estimated total number of participants:	(Please enter a number between 1-99.)
Brief description of participants (e.g., age range; interests; demographic mix, such as race, gender, religion):
Your Workshop Details
Requested workshop start date:	(Please use MM/DD/YYYY format.)
If requesting a workshop that will span more than one day, please specify ending date:	(Please use MM/DD/YYYY format.)
Requested workshop time(s):
Location where workshop will be held:
Can this location accommodate a semi-circular seating arrangement?	Yes No
If no, please describe the seating limitation:	Immovable furniture Heavy furniture Moveable furniture, but not practical or too crowded for semi-circular seating Other (please describe):
Does the location have a working computer available?	Yes No
Does the location have a working multimedia projector available?	Yes No
Does the location have an easel and flip chart or a board with markers available?	Yes No
Can you provide photocopies of handouts and make them available at your workshop?	Yes No
Goals & Expectations
Please read the NCBI Information for Workshop Sponsors and the NCBI website, then provide answers to the following questions.
What are your expectations or goals for the workshop?
What will attendees be told about participating in this workshop?
What is the attendees' level of interest or commitment to attend this workshop?
How did you hear/learn about NCBI? (Please check all that apply.)	Brochure News Article WKNC Radio Ad WolfBytes Personnel Connections Campus Colleague Student Posted Flyer Personal Email Other (Please describe):
Submit Your Meeting Request
Thank you for submitting your request! We will respond to your request within 5 business days.

NCBI Information for Workshop Sponsors

The following talking points provide more information about the NCBI workshop.

Building Bridges Workshop

The goal of Building Bridges is to mobilize participants to carry the message of acceptance and inclusion to others.

This unique workshop - interactive, experiential, and high energy - allows participants to gain self-awareness, stretch beyond their comfort zone, and gain new understanding. During this six-hour workshop (that can be taken in one day or two 3-hour sessions), participants engage in small and large group discussions and activities led by trained facilitators. Participants of the Building Bridges workshops are both contributing teachers and willing learners.

In this workshop, participants will:

Claim pride in one’s own group identities.
Identify the information and misinformation learned about ourselves and other groups.
Gain empowerment by learning ways to challenge bigoted comments and actions.

Preparing participants for the workshop:

Review workshop talking points.
Set expectations with all participants for participation in training.
Share workshop date, time, location, length with participants.
Share importance of addressing diversity and why this workshop is being held for this group.

In preparation for the workshop:

Coordinate and confirm location, date, and time with NCBI affiliate director at least 4 weeks prior to workshop.
Forward participant numbers to NCBI affiliate director at least one week prior to workshop.
Set up room: chairs (only) in half circle, table at front of room.
Provide Handouts: copy NCBI handouts for participants (provided by workshop facilitator) and bring to the workshop.
Supply equipment: two flip charts on stands with markers, LCD projector, or overhead projector.

After the workshop

Review evaluations and seek informal feedback.
Talk with facilitators to seek advice on continuing needs of the group.

Updated on 8/8/11 by EMS