PDE Program Request Form

The following request form is for those who wish to schedule one of the many programs offered by Peer Diversity Educators (PDE).

Program Requester Information

Name

E-mail

Phone

Number of Participants

Program

Special Accomodations Requested (check all that apply)
Multi-Level Room
Distance Learning
Computer Lab
Students with Vision Impairments
Students with Hearing Impairments

Other/Number of Participants

Please note: We are not available to facilitate any PDE programs on Mondays from 7-9pm and Wednesdays from 7-8pm.

Program Date

Program Time

Program Location

Program Purpose