Chancellor S Diversity Education Program: Making Excellence Inclusive

Chancellor’s Diversity Education Program: Making Excellence Inclusive

Diversity Trainer Application

Applicant Information

Full Name: / Date:
Last / First / # years on campus
Phone: / E-mail address:
Department: / Current Classification:
Supervisor: / Supervisor email:
Last, First
Dept. Head: / Department Head email:
Last, First

Training Experience

Please list training experiences in which you were the trainer. List only experiences with adult learners. Use additional sheets if necessary.
Type of Training: Year:
Number of sessions:
Average Number of Participants:
Description:
Type of Training: Year:
Number of sessions:
Average Number of Participants:
Description:
Type of Training: Year:
Number of sessions:
Average Number of Participants:
Description:

Education or Training in Subject Matter

Please identify any educational courses or trainings that you have taken that are related to the topics of social justice, diversity, or cultural competence. Use additional sheets if necessary.
Type of Educational Activity: Year:
Description:
Type of Educational Activity: Year:
Description:
Type of Educational Activity: Year:
Description:

Applicant Statement

Please write a brief statement in response to the following questions. Use additional sheets if necessary.
1.  What is your motivation for applying to be a Diversity Trainer?
2.  In our trainer selection process, one goal is to include the broadest range of diversity, e.g., race, ethnicity, sexual orientation, gender, etc. How would you say that your participation as a diversity trainer would contribute to that goal? (For example: Do you bring a particular perspective on a diversity issue?)

Approvals and Signatures

As the participant’s supervisor, I understand that participation as a diversity trainer of my employee will require approximately 20 - 30 hours of release time during the academic year to fulfill the responsibilities of the position. I am willing to consider this activity as professional development for the applicant and grant professional development release time according to applicable University policy and bargaining contracts.
Supervisor’s Signature / Date
As a participant, I agree to attend the Train the Trainer workshops, retreats, and training sessions as scheduled. I agree to facilitate at least two workshops during the academic year.
Applicant’s Signature / Date
Please return your completed application to Seana Nuñez-Grider in Human Resources via campus mail, or email to:

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