Jones Center Ambassador Program or Service Request

Student/Faculty/Staff Program Request Form

Please use the fields below to request a Jones Center Ambassador program or workshop. Please be as detailed as possible in your request, and an JCA will be in touch shortly to confirm their attendance. Please note JCAs are unavailable to facilitate programs or workshops Wednesdays from 3:00 pm-5:00 pm.

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Your Name:
(please enter your complete first and last name)

Email address:
(please enter a valid email addresss where we can contact you)

Your Phone #:
(please enter your phone number including area code)

Your UT or Knoxville affiliation:
(UT Department or outside of UT organization/business)

Event Date:

Event Start Time:

Event End Time:

Program Location
classroom building/number, meeting room number, off campus address, etc.

How many people will be attending this program?

What is the focus of the program?

Tell us about your group.
Is this for a class or organization? What is their year in school, gender, etc.?

Please check the stage of group development your group is currently in based on Tuckman's Model of Group Development.

Forming: The group has been newly established and is still in the "getting to know you" stage

Storming: A comfort level is being established and conflict may arise with the group

Norming: The group is becoming cohesive and is comfortable in freely sharing ideas

Performing: The group is productive, independent, and is both task and people oriented

Adjourning: The group is in its final stage and members are beginning to exit/graduate

N/A: This is an open event for all students and is thus not targetted at a specific group

Additional Information
Is there any additional information we should know about your group or the program location (special needs of the group, challenges, layout of space, etc.)?