Wufoo

1. First Name *
Last Name *
2. Email (Please enter an active e-mail address. This will be used for any changes or to e-mail you a reminder before the training/s.) *
3. Please let us know your affiliation. Please choose all that apply. *
UIC Student UIC Faculty UIC Staff UIC Alumnus/a Community Member (Non-UIC) Faculty/Staff from Another College/University Other
4. Please let us know your department name, student organization, or name of the community organization you're representing.
5. Safe Zone Trainings Dates & Times

Please check any of the trainings listed below that you want to register for. You can register for multiple trainings. Currently, for some trainings we might only have dates, times, and East or West Campus location determined. By the end of January, we will have an exact room and building address. We will e-mail participants this information well in advance.
Safe Zone 101; Prerequisite: None; African-American: Tuesday, February 26, 2013 (East Side), 2-5PM ; room 302 Student Center East, 750 S. Halsted
Safe Zone 101; Prerequisite: None; Asian American; Date is being re-scheduled.
Safe Zone 102A Transgender; Pre-requisite Safe Zone 101; Tuesday, March 19, 2013 (East Side), 9:15-11:30AM; Room 1155 BSB, 1007 W. Harrison St.
Safe Zone 102B Bisexual; Prerequisite: Safe Zone 101 (East Side); Wednesday, March 6, 2013, 3-5PM (DEBUT); 320 Stevenson Hall
Safe Zone 201; Thursday, April 18, 2013 (West Side), 9AM-11AM; 430C College of Dentistry; 801 S. Paulina
6. Please rate your knowledge on being an ally to the diverse lesbian, gay, bisexual, transgender, and queer communities. *
0- Don't Know 1- Not Knowledgeable 2- Somewhat Knowledgeable 3- Okay 4- Knowledgeable 5- Very Knowledgeable
7. Please let us know if you need any specific accommodations or anything that you think the trainer needs to know to make the training enjoyable and effective for you.
Thank you so much for your registration. If you have any questions, please contact the Gender & Sexuality Center at lgbtqa@uic.edu or 312-413-8619.

www.gsc.uic.edu
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Wufoo

5. Safe Zone Trainings Dates & Times

Thank you so much for your registration. If you have any questions, please contact the Gender & Sexuality Center at lgbtqa@uic.edu or 312-413-8619. www.gsc.uic.edu

Thank you so much for your registration. If you have any questions, please contact the Gender & Sexuality Center at lgbtqa@uic.edu or 312-413-8619.

www.gsc.uic.edu