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41 Windsor Valley Place
Courtice, ON Canada L1E 1J4

416-494-2263

Please take a few minutes to complete this Service Request Form so we may be better able to meet your needs.

We look forward to working with you!

Service Request Form

Name of Organization

Website/URL

Organization Address

Description of Your Organization

Name of Primary Contact

Primary Contact Phone

Primary Contact Email

Type of Service Needed

Anticipated Timeframe

Intended Number of Participants and Audience

Budget

What challenges are you aiming to resolve through this process?

What internal or external factors are motivating or driving this initiative? Why is this service, training or development being requested?

Is there a DEI committee?

Yes

Has your organization conducted any internal assessments in relation to DEI? If so, what kind? (e.g. survey)

If you were referred to DiversiPro, who referred you and what is your relationship to them?

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If you are human, leave this field blank.

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