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Parker College DEI Request Support Form

The Parker College DEI committee seeks the perspective of our community as we work to foster and create a more inclusive environment where members feel heard, seen, and validated. The information provided here will help us achieve these efforts.

Do you need support but aren't sure where to start? Use this form to find out what resources are available to assist you.

Please be aware that this is NOT an incident report form. If you experienced or witnessed an incident, please contact the Title IX/EEO office to file a report (https://president.georgiasouthern.edu/eeo-titleix/). If this is a current health or safety emergency please contact 911 immediately. Shared information that relates to sexual misconduct, discrimination based on protected class, or similar incident will be reported to the appropriate campus office.

All questions in this form are optional.

With which gender do you currently identify?

Male
Non-binary
Female
Not listed:

Choose one or more races that you consider yourself to be:

White

Asian

Black or African American

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Other

Do you identify as Hispanic?

Yes
No
Rather not say/unsure

Full Name

Enter this information (as well as your preferred method of contact below) ONLY if you would like us to get in touch with you.

Please select and provide your preferred method of contact.

email
Phone
I do not wish to be contacted

Please briefly describe the issue or difficulty that you are experiencing related to DEI.

Have you already reached out to any other offices on campus?

Yes
Maybe
No

If yes, please briefly let us know which offices you have reached out to.