DIVERSITY DEVELOPMENT PROGRAM APPLICATION

Name
Campus/ Phone
Department
Campus/ Address
Title
E-Mail Address
Zot Code
Supervisor's Name and Title

Please provide a brief statement regarding your expectations and goals for this program (please feel free to print out and attach additional pages).

What do you feel are three topics or issues most important to the discussion of diversity?

Any additional information relevant to the program you would like to provide:

Please submit this application by December 15.

Submit online or print and fax/mail this application to:

Office of Equal Opportunity and Diversity (OEOD)
103 MSTB
Zot Code 1130
Ph:(949) 824-5594
Fax:(949)824-2112
eod@uci.edu