Member Registration Form

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You are registering as an individual to become a member of the Greater Williamsburg Trauma-Informed Community Network.

Membership in the GWTICN is open to any interested individual who:

1. Desires to work together at being a more trauma-aware & informed community; and
2. Will meet regularly at General Membership meetings to inform personal and professional development in trauma-informed care.

You are especially encouraged to register if:

You live in Williamsburg, James City County, York County or Poquoson.
You live with the experience of trauma.
You are a community influencer or well-connected.
You are non-conforming, marginalized as a result of your ethnicity or immigration status, or identify as a LGBTQIA youth or young adult.

Benefits of Membership:

You can serve on a Strategic Committee to implement programming, policy & practices.
You can propose the creation of working groups or sub-committees.
You will receive updates & information from the Network through the GWTICN listserv.
You will use your best assets in an inclusive space that respects creative doers & thinkers!

Contact the Network with any questions at: GWTICN757@gmail.com

Email *

Name & Pronouns *

Locality *

You are not officially representing any locality by listing it here. We collect this information to inform our diversity, equity & inclusion strategies AND/OR, if you chose to serve on our Steering Committee, to ensure we have a voice in leadership from each locality.

Organization *

You are not officially representing any organization by listing it here. We collect this information to inform our diversity, equity & inclusion strategies. Type N/A if this does not apply to you.

What personal or professional assets can you bring to this Membership? *

Think outside the box. Any collaborative effort needs a variety of skills & resources. Think about what you are genuinely good at doing. Think about what you own and what you have access to. Think about your artistic/creative abilities.

Physical/Natural Assets - Do you have access to any brick & mortar location or accessible space? Do you have access to any equipment, computers or copiers? Do you have access to any farm land or food/water resources

Skills/Knowledge Assets - Are you good at data sets? Are you bi-lingual? Are you a software whiz? Are you a media guru? Are you an artist of any kind? Are you writer/editor, public speaker, or skilled communicator?

Social Assets - Do you belong to any professional associations? Do you own a business? Do you lead others in any capacity? Do you have political connections?

Capital Assets - Do you have access to human or financial capital?

Required

Please specify and lists the assets you bring to this Membership. *

How can this Network help? Can you share specific trauma-informed needs as it relates to the different populations in our community? *

Think of your own understanding of "trauma" and being "trauma-informed" - What more would you like to know? Think about your neighbors and how they present themselves in different spaces - How much of their behavior is related to a history of traumatic experiences? Type "N/A" if you have nothing to share at this time.

Are you interested in joining one of these four (4) Committees? These committees will work to implement the Network's Strategic Plan. *

Public Awareness Committee - Creates a range of community platforms to acknowledge trauma, build empathy & resilience; Training Committee - Provides a customizable menu of trauma-informed training opportunities; Assessment & Indicators Committee - Develops community-wide indicators to measure progress

Public Awareness Committee

Training Committee

Assessment & Indicators Committee

Racial-Trauma Committee

I am not interested

1st choice

2nd choice

3rd choice

4th choice

Have you been trained in Adverse Childhood Experiences and/or its relationship to trauma? *

Do not let your response to this question impact your readiness to be a member of our Network

Yes, I have received basic training and would be interested in further education/training.

Yes, I have received basic training but I could benefit from a refresher course in the basics.

Yes, I am trained in ACEs and its relationship to individual trauma, and at least one of the following trauma types: Collective, Participant, Structural, Historical, Economic

No, I have never received basic training in ACEs and/or trauma.

Other:

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