In order to ensure that there is ample space to spread out and socially distance, please indicate if you plan to attend the morning, afternoon, or both sessions of the retreat. To ensure that there is ample space to socially distance, please indicate if you plan to attend the morning, afternoon, or both sessions of the retreat. I will only attend the morning session: 9am - 1pm I will only attend the afternoon session: 1pm - 5pm I will attend both the morning and afternoon sessions: 9am - 5pm Name Name First Name Last Name Please use your umass.edu email to register: Email College/School College/School * College of Education College of Engineering College of Humanities and Fine Arts College of Information and Computer Sciences College of Natural Sciences College or Nursing College of Social and Behavioral Sciences Isenberg School of Management School of Public Health and Health Sciences Other… Enter other… Department Department * Appointment Appointment * Lecturer Senior Lecturer Senior Lecturer II Assistant Professor Associate Professor Full Professor Assistant Professor - Clinical, Extension or Research Associate Professor - Clinical, Extension or Research Full Professor - Clinical, Extension or Research Instructor Librarian Administrator Other… Enter other… Optional Responses While your confidential responses to the following questions are not required, this information helps OFD produce programs to support equity and inclusion for every member of our community. Do you have any accessibility needs that we should know about? No Yes. Please explain: Enter other… Race/Ethnicity (please select all that apply) Race/Ethnicity: (select all that apply) American Indian/Alaska Native Asian/Asian American Black/African American Hispanic/Latinx Native Hawaiian/Pacific Islander White Self-describe: Enter other… Gender: Gender: Woman Man Non-binary/Non-conforming Self-describe: Enter other… Do you identify as transgender? Do you identify as transgender? Yes No COVID-19 Event Guidance Attendees of OFD in-person events are asked to follow the current COVID-19 guidelines from UMass Amherst Environmental Health and Safety, which includes staying at home if feeling ill, particularly if experiencing COVID symptoms. For the complete list of guidelines, visit the EH&S COVID-19 Response site: https://ehs.umass.edu/covid-19-response Event Accessibility UMass Amherst is committed to coordinating accessible events to the best of our ability and to the extent possible. If you need a disability-related accommodation to participate in this activity/event please contact the UMass Accessible Workplace Office. Leave this field blank