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Leadership & Service Ambassador Program or Service Request

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Student/Faculty/Staff Program Request Form

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

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(please enter your complete first and last name)

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

(please enter your phone number including area code)

(UT Department or outside of UT organization/business)
Event Date:

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

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.

Program Focus
Please check all topic areas that you would like the Leadership & Service Ambassadors to address in their upcoming program. Visit http://leadershipandservice.utk.edu/ambassadors/lsa-programs/ for a complete listing of program examples.
Teams and Teambuilding
Leadership Principles and Application
Social Justice
Service, Volunteerism & Servant Leadership
What is the Center for Leadership and Service?

What are your goals for the workshop?
Topics listed above are for planning purposes, to personalize your experience, please list any specific goals or outcomes below.

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.)?

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