Application to become a new CAR chapter Sept 2019/ June 2020
This is the application form that your Chapter must submit before 30th August, if you wish to become a new Chapter with CAR starting September 2019.

For more info on the Campaign Against Racism:
http://www.socialmedicineconsortium.org/campaign-against-racism

IMPORTANT - Please see our criteria for accepting New Chapters (still under review) before you proceed to the application
https://docs.google.com/document/d/1CNpkExXnnPTNd-civqyOjjxl8FNFgE6corguzUGI0CE/edit

Name of Chapter *
Your answer
Email *
Your answer
Name of Chapter Representative (s) (the person responsible for establishing and developing the chapter who will be the point of contact) *
Your answer
Would the chapter take place at an existing Institution?If so, please write the name of the institution *
Your answer
Can you please explain what the Chapter understands as structural racism and the impact on health in your context? *
Your answer
Can you explain your experience of the intersection of racism and capitalism and the impact on health in your context? *
Your answer
What is the strategic goal of your Chapter? *
Your answer
Can you give some examples of anti-racism actions which you think you will take to achieve your strategic goal? *
Your answer
Can you describe some of the challenges you foresee in setting up a Chapter and how you intend on overcoming these challenges? *
Your answer
Please describe how you intend on practising distributive leadership wihin your chapter? Marshall Ganz definition of distributive leadership : Leadership requires “accepting responsibility for enabling others to achieve purpose under conditions of uncertainty” It is leadership from the perspective of a “learner” This kind of leadership is a form of practice - not a position or a person – and it can be exercised from any location within or without a structure of authority. *
Your answer
Can you take responsibility to ensure that a representative from your chapter can attend our second annual CAR organizing retreat in the US (exact location to be confirmed) 25th/26th/27th October, knowing that room and board will be covered and that scholarships for travel will be available *
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