Ginsberg Center Support Request Form

Ginsberg Center staff can connect your student organizations, courses, research and programs to reciprocal community engagement experiences. The information gathered in this Request Form allows us to better understand your needs before a more in-depth conversation. It should take less than 5 minutes to complete.

Due to our staff capacity, we cannot guarantee availability for your preferred workshop or meeting date(s). After form submission, you will be contacted by our staff to discuss scheduling options.

Additionally, we are unable to offer individual workshops to groups smaller than 10.

First Name:

Last Name:

Email:

Phone Number:

Your Affiliation (please check all that apply):

FacultyGraduate Student Instructor/Teaching AssistantStudentProgram Staff

Your School or Unit:

Your Department/Program/Student Organization:

Have you worked with Ginsberg Center before?

YesNo

Referral Information

How did you hear about the Ginsberg Center?

UM faculty memberUM staff memberUM studentInternet ResearchThe Ginsberg Weekly newsletterGinsberg Center FacebookGinsberg Center TwitterUniversity of Michigan publication (MPlanner, e.g)Community organization or associationOther

Have you been in touch with someone at the Ginsberg Center about this current request already? If so, who?

What are you requesting support for:

# of Undergrad students involved?

# of Graduate students involved?

Student Group Support

What is your student classification?

What type of support for your student group are you looking for? (check all that apply)

Advising/ConsultationWorkshop/Training for community engagementFinding funding for a community engaged projectConnecting to community partners for a project or a collaborationIdentifying community partners for a service opportunity (e.g. group volunteer/service day)Other

Other Details:

What do you hope to learn and/or take away from your advising session?

Please list at least 3 days/times you are available to meet to further discuss your needs:

Course Information

Please list the Course Title (include number and descriptive name)

When is the course offered (check all that apply)?

Fall WinterSpringSummer

Is this a (check all that apply):

New CourseExisting CourseOnline CourseHybrid Course

Does this course engage in local, domestic, or international community work? (please check all that apply)

LocalDomesticInternational

How can the Ginsberg Center support your course? (Check all that apply):

Help prepare your students and GSIs for community engagement (ex: workshops)Learn about Ginsberg’s network of community organizations and potential partnershipsConsultation and resources for your community engaged teaching (ex: course, program and assignment design; best practices for CE teaching & learning; equitable partnerships)Consultation and resources for your community engaged research and scholarship (e.g. publishing, strategies for equitable community partnerships and collaboration)Assessing impact of courses on community organizations and student learningInformation on nonpartisan voter registration and other democratic engagement opportunitiesGrants and funding opportunitiesOther

Other Details:

Please upload your course syllabus, if available (.pdf, .doc, .docx). If you prefer, you can email the syllabus to us at ginsberg.engage@umich.edu.

If you do not have a syllabus ready to share, please share information about your course that will help us prepare for our consultation with you.

Program Information

Please list the program title:

Please provide a short program description or website link:

Does this program engage in local, domestic, or international community work? (please check all that apply)

LocalDomesticInternational

How can the Ginsberg Center support your program? (Check all that apply):

Help prepare your students and GSIs for community engagement (ex: workshops)Learn about Ginsberg’s network of community organizations and potential partnershipsConsultation and resources for your community engaged program (ex: course, program and assignment design; best practices for CE teaching & learning; equitable partnerships)Consultation and resources for your community engaged research and scholarship (e.g. publishing, strategies for equitable community partnerships and collaboration)Assessing impact of programs on community organizations and student learningInformation on nonpartisan voter registration and other democratic engagement opportunitiesGrants and funding opportunitiesOther

Other Details:

Please share information about your program that will help us prepare for our consultation with you.

Research Information

Research Project Title:

Please provide a short description of your research project or website link:

Does this research engage in local, domestic, or international community work? (please check all that apply)

LocalDomesticInternational

How can the Ginsberg Center support your research? (Check all that apply):

Other Details:

Please provide any additional information below:

Other

What kind of support would you like from the Ginsberg Center?

The Ginsberg Center offers workshops that introduce students, faculty, and staff to ethical community engagement. Our workshops help participants develop skills to participate in, reflect on, design, and lead community engagement experiences. Ginsberg staff can discuss how a workshop can best support the needs of your group.

Please note:

For classes or student organizations with less than 10 students, our Learning in Community Workshop Series includes a number of our most commonly requested workshops as public sessions open to all students. Please visit our calendar of events for more information.

Due to our staff capacity, we cannot guarantee availability for your preferred workshop or meeting date(s). After form submission, you will be contacted by our staff to discuss scheduling options.

Would you like the Ginsberg Center to offer a workshop for your course, program, project or student organization?

Workshop Information

Preferred Date(s) & Time(s) of Workshop

Our workshops require a minimum of 50 mins of dedicated time to achieve basic learning objectives. More time is required for significant participant discussion and interactivity. How many minutes of time have you reserved for this workshop?

506090120I’m flexible

Is this workshop virtual or in-person? (At this time we cannot accommodate hybrid workshops.)

Room location (if available):

Is A/V (computer/projector) available in the room?

Expected number of participants:

To help us track session attendance, please share a google spreadsheet link with attendee roster. Please include attendee names and uniqnames/email address (or send by email to ginsberg.workshops@umich.edu).

Who is the target audience for this workshop?

FacultyStaffUndergraduate StudentsGraduate Students

What are the major learning goals you have for participants in this workshop? What do you hope participants will know or be able to do after completing this workshop?

How would you describe the workshop participants’ previous experience with or preparation for community engagement?

Do any participants require accommodations?

YesNoUnsure

Please list at least 3 days/times you are available to meet to further discuss your needs:

Please provide any additional information below:

Please note: Our workshops are designed for groups of 10 or more. If you have less than 10 participants, our Learning in Community workshops offer similar content and are open to all students on campus. Please encourage your participants to register for one of our upcoming sessions.