DEI Certificate 2023 Application Form This form is for those applying for the 2023 CoHort of the EWU DEI Certificate Program. Please fill out the application completely for full consideration. Contact information(Required) First Last Pronouns Title and Organization(Required) Position Title Organization Email and Phone(Required) Contact Email Contact Phone Briefly describe your organization.(Required)[i.e. Industry, type of organization, number of employees, populations you serve…]In your current organization, what is the structure for diversity, equity and inclusion. In other words, who is responsible for DEI?(Required)[i.e. A division, a person, everyone, Human Resources, no DEI personnel.]Tell us why you are interested in this particular professional development opportunity.(Required)If you are selected for this program, how do you think it would impact you and/or your organization?(Required)Cost and PaymentDEI Certificate Cost:(Required)Regular Registration (after September 5)Early Bird Registration (by September 4)Regular Registration Eligible for 20% Discount (after September 5)Early Bird Registration Eligible for 20% Discount (by September 4)Discounts[Individuals in any of these categories are eligible for a 20% discount.] I am currently an active EWU faculty, staff, or student. I am alumni of Eastern Washington University I am a member of Greater Spokane Incorporated I am employed by a 501c3 nonprofit entity Waitlist In the event that the program is full, please waitlist me. Total Due: Upon acceptance into the program, you will receive an email with payment information. Δ