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D&I Charter Community Leadership Program application form

The Regional Diversity Roundtable of Peel Region is currently accepting applications for the second round of the Diversity & Inclusion (D&I Charter) Community Leadership Program or CLP.

The CLP will run from December 2019 to September 2020, bringing together 35 diverse community-builders to grow leadership skills and develop community projects to advance equity and inclusion across Peel Region.

For more detailed information about CLP programming and eligibility, visit tinyurl.com/RDRCLP.

Your responses to this form are confidential, and will only be read by Regional Diversity Roundtable staff and the CLP Selection Panel, formed by project and contract personnel.

If you have any questions about the programming or require any support, please contact Saira Zuberi, CLP Lead (saira@regionaldiversityroundtable.org or 905 232 7371).

And just a tip! We recommend setting aside 30-90 minutes to complete and submit the form. For open-ended questions, we advise writing answers in a separate Word document. Then copy and paste your replies into this form when you're done!

APPLICATION DEADLINE: TUESDAY 15th OCTOBER 2019, MIDNIGHT!
1. First Name *
Your answer
2. Last Name *
Your answer
3. Nickname / Preferred Name (if applicable)
Your answer
4. Pronouns (for example: she/her, he/him, they/their, ...) *
Your answer
5. e-Mail Address *
Your answer
6. Mailing Address *
Your answer
7. City *
8. Postal Code *
Your answer
9. Mobile Phone *
Your answer
10. Other Phone
Your answer
11. Age Range *
(You must be 18 years or older by 1 January 2020 in order to apply!)
12. How did you learn about the D&I Charter Community Leadership Program? *
13. Online collaboration will be required for the CLP, so we'd like to know which of the following tools you're comfortable using (select all that apply): *
Note: This is not meant as an exhaustive list. Successful applicants will be working in Community Project teams and teams may choose other internet and communications tools. Below are tools that may be used in the CLP.
Required
14. Putting on the CLP is a significant investment in time and resources, for organizers and the funder as well as for participants. If your application is successful, are you able to make the following time commitment between Dec. 2019 and Sept. 2020?: *
The time commitment includes all CLP session dates/times listed below, plus additional teamwork and personal reflection work (estimated 5-7 hours per month). Full-day sessions are one Saturday a month (9:30-4:30, on 18 Jan., 22 Feb., 28 Mar., 25 Apr., 30 May, 20 June, and 18 July), plus two shorter launch and closing events on 4 December 2019 and 19 September 2020. All programming will be held in accessible locations.
15. In what country were you born? *
Your answer
16. In what country/ies were your parents born? *
Your answer
17. What is (are) the first language(s) you learned? *
Your answer
18. What other language(s) do you speak fluently (as applicable)?: *
Your answer
19. We seek to engage as diverse and dynamic a group as possible for this program. Many different aspects of identity will also be covered in the CLP programming, and no one identity will be valued above any other. The goal is to create as inclusive and enabling a learning community as we can! To that end, tell us: How do you self-identify? *
Note: You may include race, gender identity, ethnic or cultural background, sexual orientation, ability, talent or skill, religious identification/faith community, migration status, family status, or human attributes of any kind. Feel free to include any communities (social, political, geographic, professional or other) you identify with, and anything you feel makes you who you are! [And just a tip!: There is a 1,500 character limit for answers to open-ended questions. We recommend setting aside 30-90 minutes to write long-form answers in a separate Word document. Then copy and paste your answers into the online form when you're ready to submit!]
Your answer
20. What skills, experiences and passions do you have that will make you an effective champion of diversity, equity and inclusion? *
[1,500 characters maximum]
Your answer
21. Choose one of the following three options as your final question! *
Required
22. Enter your personal response to the question you chose above: *
[1,500 characters or less]
Your answer
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