First Name *

Last Name *

G-number: *

Email *

Phone *

Campus Address: *

Department: *

Job Title: *

Job Type: *
- Select Option Faculty Staff

Date Tenured or probationary status completed: *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960

Note: Must be off probationary period

Start Date With GVSU: *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960

Have you participated in training in the past year? *
- Select Option Yes No

If yes, date(s) of training? *

Note: The DEI online module will be made available upon receipt and approval of application

Please list your previous work, service or learning experiences that are related to advocating for inclusion (across any dimension of diversity, including: age, color, disability, familial status, height, marital status, national origin, political affiliation, race, religion, sex/gender, sexual orientation, gender identity and expression, veteran status, or weight etc.):

Please list your previous work, service or learning experiences that are related to advocating for inclusion: *

Please state why you would like to become an inclusion advocate: *

Please describe the strengths you bring to this role: *

Please list any other information you feel is relevant: *