Safe Zone Panel Request Form

Thank you for your interest in scheduling a Panel - we look forward to working with you! Please submit this form a minimum of 30 days prior to your first requested date (even if we have fulfilled past requests). The sooner we have your request, the more likely we can fulfill it.*

Responsibilities of LGBTQ Affairs include:

  1. Contacting you within a week of receiving this request to say we are working to find panelists for your class or training, or that we will be unable to fulfill your request at this time.
  2. If necessary, work with you to tailor the panel to the needs of your department, organization, or class.
  3. Confirm the details of the panel with you once we have secured panelists.

Responsibilities of the contact person include:

  1. Ensure the class or training the panel is requested for has a minimum of 20 confirmed participants and advertise it to your intended audience.
  2. Secure a venue and any agreed upon A/V equipment.
  3. Print any necessary materials for all participants (if we agree on supplemental materials)
  4. Provide snacks and beverages if desired.

If you have questions about this form or about the request process, please contact the Graduate Assistant for Ally Development at

Contact Person
Example: (000)000-0000
Panel Requested for:
Please list the proposed dates/times and location(s) of the panel(s)
*Please note: Panels are composed of a cadre of generous volunteers who share their stories so attendees can connect with the LGBTQ experience. Thus, even with 30 days notice, we cannot guarantee that we can fulfill your request until we secure these volunteers. We promise to do so as soon as possible. We honor requests on a first come, first serve basis, and we work hard to fulfill as many requests as possible. Thank you in advance for your understanding.
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