Oberlin Ombuds Office

Name:

Campus e-mail:

Campus address (if known):

Home/permanent address:

Campus phone (if known):

Home/permanent phone:

Please indicate if you are:
First Year Sophomore Junior Senior

Major (if known):

Year of graduation:

To ensure the effectiveness of the Institute, it is essential that participants come from diverse backgrounds. Please answer the following questions as completely as possible. All answers will be kept confidential.

Please identify yourself in terms of socioeconomic background, gender pronouns, primary language, religion, ethnicity, age, sexual orientation, disability status, political orientation, etc.

Why do you want to participate in the Social Justice Institute?

What skills or other qualities enhance your ability to work with controversial issues in diverse groups?

Anything else you would like us to know about you?