2016-2017 APILR MENTOR APPLICATION: January 27-29, 2017

*Note: People applying to APILR as a first-time Participant should fill out another form*

APILR Background
The 23rd Annual Asian Pacific Islander Leadership Retreat (APILR) empowers students with the necessary leadership skills and resources to make a difference on campus and in their communities through an examination of self-identity, current API community issues, and an application of skills to the communities. This will be accomplished through workshops and activities focused on self-awareness and self-application. Mentors serve as group facilitators as well as community resources to APILR participants. Mentors will facilitate debrief, uphold APILR community agreements and assure safety of APILR attendees. Lastly we encourage mentor to foster relations with participants well after the retreat as a continued resource.

Application Deadline
Please submit your application by Monday, November 7, 2016 to be considered. All applications submitted after this time will be taken into consideration only if there is space available.

Selection Criteria
Mentors for APILR are in charge of leading small groups in discussions and activities, as well as helping build community during the course of the weekend. There will be a required weekend training prior to APILR for all mentors. The selection committee will review applications and inform applicants via email on November 21, 2016. Individuals selected to participate are required to pay a $30 registration fee or submit a fee waiver with their application by November 28th, 2016 in order to keep their spot. Individuals not selected in the first round will be placed on a waiting list.

Registration Fee and Liability
If you are selected to attend there will be a participation fee of $30. Further instructions will be announced later regarding payment. You will be required to fill out the Waiver of Liability form when you submit your NON-REFUNDABLE and NON-TRANSFERABLE payment. Participation fees include transportation, room and board, and all retreat materials.

Itinerary
Friday. January 27th, 2017: The bus will depart from UC Davis to the retreat site on Friday afternoon. The estimated time of arrival will depend on pending traffic. More details about departure will be given at a later time.
Sunday. January 29th, 2017: We will depart from the retreat site at approximately 2:00pm and should be back to the UC Davis campus no later than 4:00pm

Please Note
Students will not be permitted to drive themselves to the retreat site. You must travel via charter bus with the group, so please plan accordingly.

If you would like a letter verifying your participation for an academic or work related reason, please notify Kriti Garg at: kgarg@ucdavis.edu at least two weeks before you need the letter.

Contact Information
If you have any questions please contact:

Mandy Lew
APILR/APCW Student Coordinator
mglew@ucdavis.edu

Kathy Vu
APILR/APCW Student Coordinator
kuvu@ucdavis.edu

Kriti Garg
CCC Program Advisor/Coordinator
kgarg@ucdavis.edu

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    General Information

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    Demographic Information

    This section is optional and will not affect your eligibility for APILR. It is for the planning committee to determine whether or not we have done successful outreach to diverse communities.
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    Emergency Contact Information

    Please list someone who is not also attending the retreat, and who would be able to make medical decisions for you in case of emergency.
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    Health Information

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    Please answer the following questions to the best of your ability.

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    Please Note: Mentors are required to attend a MANDATORY day of training.

    Mentor training will take place on January 21st, 2017, 10am-4pm in the Cross Cultural Center.
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    Statement of Agreement

    If I am selected to participate, I agree to follow all University Policies and guidelines including support for the principles of community, abstaining from alcohol consumption, and engaging in the use of illegal drugs while attending the conference. Furthermore, I understand that I am committed to attending the entire retreat. Early departure will not be allowed unless there is an emergency.
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    By typing your name on the signature line, you verify yourself as the named applicant and agree to all information and policies outlined in this application. **lf under 18 years of age, a signature of parent or guardian is necessary**