Safe Zone Project Response Form
                   

If you are interested in participating in the Safe Zone Project, please
complete the following information and send to the address listed below.

University Status:                Best time to attend training?
                                  (check all that apply)
__ Staff                         
 
__ Faculty                        __ Morning

__ Student                        __ Afternoon

__ Community                      __ Evening



Current knowledge level           Would you be interested in 
of LGBT issues:                   participating in a
                                  Safe Zone listserve?
__ Little or none

__ Some knowledge                 __ Yes

__ Extensive knowledge            __ No



How did you find out about the Safe Zone Project?




_______________________________________________________________________



Please provide the following.  We will contact you with available
training times.



______________________________        _________________________________
Name                                  Campus Address


______________________________        _________________________________
Work Phone Number                     E-mail address



Send to:

Kathy Last 
University of Iowa
Office of Equal Opportunity and Diversity
202 Jessup Hall
Iowa City, IA  52242-1316