Inclusion Champion Verification Form

If you have completed the requirements of the program, please fill out this short questionnaire to let us know.

Read more about the Inclusion Champion Program.

Please fill out this form to receive your Inclusion Champion certificate and pin!

Inclusion Champion Completion Requirements
Complete 9 hours of core workshops (ABCs of Diversity, Inclusive Communication, Understanding Power and Privilege) and 6 hours of elective topics. | Note: students must keep track of courses and verify with us to receive certificate
Full name*
Please use the name UCF has on file for you, not any nicknames.
Name as you would like it to appear on your certificate if it is different than above
Please include any titles, prefixes, suffixes, middle initials, etc.
UCF email address*
Either @knights.ucf.edu or @ucf.edu
Faculty and staff only: office mailing location INCLUDING +FOUR
Students, alumni, and community members must pick up certificate and pin from our office in the Barbara Ying Center (12701 Scholarship Drive, Bldg. 81, Suite 102)
Current role(s) at the university*
- Faculty
- Staff
- Student
- Alumni
- Community member
Please select all that currently apply.
Course History
Please indicate the dates of your enrollment in the three core workshops. All information is subject to verification by ODI.
What date did you take ABCs of Diversity?*
MM
DD
YYYY
What date did you take Inclusive Communication?*
MM
DD
YYYY
What date did you take Understanding Power and Privilege?*
MM
DD
YYYY

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