Undivided Leadership Program Application
Thank you for your interest in the Undivided Leadership Program. We are excited to receive your application!
Please ensure you have read the program description on our website: http://contemplativejustice.org/mediacast/undivided/ prior to filling out this form.

If you need to fill this form out in more than one sitting, please click through until you reach the last page and read the directions at the bottom of the page. Make sure you save the link as we are unable to access this link later on your behalf. If you have questions, or need assistance with this form, please email Christina Kinch at christina@contemplativejustice.org.

Name
Your answer
Email
Your answer
Phone
Your answer
Age
Your answer
What city/cities will you be living in 2018?
Your answer
What sparked your interest in participating in Undivided? (max 250 words)
Your answer
Contemplative Justice Experience
Please describe your experience with social or environmental justice efforts.
Your answer
What have you learned from these experiences? (max 200 words)
Your answer
Are you currently working on any social or environmental justice programs/ projects? Please list.
Your answer
In this program we will be exploring social change frameworks, including theories of change, allyship, anti-oppression, and systemic power analysis. Do you have any experience/ training in these areas? If so, please list. If not, what questions do you have?
Your answer
Tree of Contemplative Practices
Please describe your experience with contemplative or spiritual practices.
Your answer
What have you learned from these experiences ? (max 200 words)
Your answer
Do you currently engage in any regular contemplative practices?
Your answer
Community Life and Social Change
In what ways do you hope that your participation in Undivided will support your personal and spiritual growth? (max 200 words)
Your answer
In what ways you do hope that your participation in Undivided will benefit your wider communities? (max 200 words)
Your answer
Please describe a time when you were part of a dysfunctional group. How did you respond? What did you learn?
Your answer
Please describe a time you had a conversation with someone whose beliefs or values you strongly disagreed with. What was your approach to that conversation? In what ways would your approach be the same or different in the future?
Your answer
What unique skills and perspectives will you contribute to the program?
Your answer
This program will require participation at all 4 weekend gatherings in February, April, August and October 2018. Do you know of anything that might prevent your participation?
Your answer
Group projects and individual reading / study will be required between gatherings. Are you willing to commit time between gatherings to this work?
Undivided requires a personal commitment of time, energy and heart. It also requires people in our lives to be on board and support us. What in your life might you need to let go of, or say no to, in order to make room for this commitment? What family or community supports might you need to draw on in order to make your full participation possible?
Your answer
What else would you like us to know about you?
Your answer
Help us get to know you better.
Undivided is committed to inclusion across many aspects of identity. Your answers to these questions will help us design the program and ensure we bring together a strong and diverse cohort. We know our community will learn better and the experience will be richer for everyone if the conversation includes people with many perspectives and lived experiences. These questions are designed to give us a sense of some of the perspectives you bring.
What is your gender identity? (Ex. femme, non-binary, two-spirit, man, woman etc)
Your answer
What pronouns do you use? (Ex. ze, she, they, he etc)
Your answer
Please tell us about your race and/or ethnicity.
Your answer
Would you like to share anything about your sexual orientation? (Ex. asexual, bisexual, lesbian, queer, gay, heterosexual)
Your answer
Do you have any mental, emotional or physical health challenges or disabilities you would like the organizers to know about?
Your answer
What other unique perspectives would you bring to the group?
Your answer
Which communities are you part of (spiritual, cultural, recreational, creative, therapeutic, supportive etc) that connect to core parts of your identity?
Your answer
Which language are you most comfortable using when describing the sacred? (you can check more than one)
Undivided is sponsored by the United Church of Canada and draws on Christian wisdom to guide and inform the program. This involves use of inclusive Christian language, practices and frameworks. We welcome, respect, and celebrate people of all and no faith backgrounds and acknowledge there are multiple ways of knowing, being and understanding. Please describe any hopes, concerns or wonderings you have about this.
Your answer
What is your connection to the United Church?
If you attend a congregation, please list
Your answer
How did you hear about this program?
This program is highly subsidized by the United Church of Canada which allows us to keep program fees low for all participants. The fee for this program is $1200 and can be paid upfront or in 3 installments of $500, $400, $300. This fee includes food, transportation from anywhere in BC, accommodation and all program activities. We also have bursaries available based on financial need. You can find the bursary application here: https://docs.google.com/forms/d/1nIpTbDSbXYdtE1F3IffUbMVL4BhuTWtsn9-I65PhNhY/prefill
I understand that upon acceptance to the program I will be asked to secure my place by sending a $100 deposit within one week of acceptance. This fee will be subtracted from my program fee.
Before submitting your completed form, please send your resume to christina@contemplativejustice.org
Is your application complete?
Thank you for your application!
If your application is complete: Click submit, we will review it and get back to you in December 2017.

If your application is incomplete and you would like to save it and come back later: Click submit. Click "edit your response" and you will be taken back to your application. Copy and save the link in your address bar (I suggest copying and pasting it into an email for yourself- subject line "Link for Undivided Application"). This link is your access point for later entry to your saved form. We will not be able to access your form for editing, although if you make a mistake saving, or lose the link, we are able to send you a pdf of your application.

If you have questions, please email Christina Kinch at christina@contemplativejustice.org

Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms