OutSpoken Youth Educator
OutSpoken is a diverse group of LGBTQ and allied youth, adults, organizations, and providers dedicated to challenging bullying, oppression and anti-LGBTQ violence in our schools and communities. An exciting employment opportunity, OutSpoken pays and trains youth to be educators and leaders who directly address and challenge the systems that impact their lives. OutSpoken offers ongoing support to youth for to strengthen job readiness skills and leadership development. ***Panelists are hired as independent contractors and paid $20/hour!***

-------------------------------------------------------------------------------------------------------------------------------------------

We’re so excited to hear the stories and experiences you have to share! To become an OutSpoken Panelists, follow the following steps:

1.) Fill out the application below.

2.) Complete the W-9 form

3.) After confirmation of application, there are then two options:

- Participate in an OutSpoken Training (we recommend following our facebook page to keep an eye out)

- OR set up a One-on-One with noor@nwnetwork.org at any time

After completing the above steps you’ll be added to the Newsletter listserv and invited to join our social media groups. Panelist may then sign up for panels, tabling, and other events voluntarily by responding to the newsletter or committing via social media.

---------------------------------------------------------------------------------------------------------------------------------------

*** Not every question is required - please fill out to the best of your ability. Don't forget to also send your W-9!! You can find this on the www.nwnetwork.org/ossb ***

Welcome to the Outspoken Speakers Bureau.

Name: *
Your answer
Today's Date
MM
/
DD
/
YYYY
Telephone Number
Your answer
Phone Number Type
Okay to Call?
Okay to Text?
Okay to Leave a Voicemail? *
Email (most used please) *
Your answer
Contact Notes:
Your answer
City, State, Zip Code *
Your answer
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Pronouns
Your answer
How would you describe your gender?
Your answer
How would you describe your sexual orientation?
Your answer
How would you describe your race?
Your answer
How would you describe your ethnicity?
Your answer
Do you identify as having a disability? If so, are there any ways we can make programming more accessible to you?
Your answer
Do you have permanent housing?
Your answer
Who do you currently live with and what's your relationship to them? List everyone if possible (e.g. mom, step dad, foster parents, siblings, friend):
Your answer
Total income of entire household: *
Your answer
Are you eligible for free/reduced-priced lunch and/or public benefits?
Your answer
What language(s) are primarily spoken at home?
Your answer
Are you a refugee or immigrant?
Are you in school now? If yes, what school and year?
Your answer
What experiences, interests and/or skills are you comfortable and knowledgeable to speak about (this helps us decide whot o put on specific panels.) Please check all that apply:
What are two goals you have for yourself in the next year?
Your answer
What would help you feel prepared to speak on a panel?
Your answer
What are ways you feel the NW Network can best support you?
Your answer
Any additional information you would like to share with the program or feel would be helpful for us to know?
Your answer
Statement of Rights
1) Every participant has the right to considerate and respectful treatment
regardless of race, color, religion, marital status, ethnicity, sexual or gender
identity, lifestyle, political ideology, legal status, economic status, physical
status, disability or national origin.

2) Every participant has the right to determine their needs and discontinue
participation in the program at any time.

3) Every participant has the right of access to the NW Network record of
information concerning them. A participant may schedule an appointment to
review this record of information. The NW Network maintains only basic
necessary program related information for the OutSpoken Program and will not
share your contact information without expressed permission.

4) A participant has the right to file a complaint with The NW Network if they feel
their rights have been violated. The participant should use the grievance
procedure outlined below. Each participant has the right of appeal in any
recommendation, opinion, or decision that is the outcome of the grievance
procedure.

Grievance Procedure
A grievance that cannot be resolved between a program participant and NW
Network staff members, should be directed to the Staff Supervisor for assistance. If
the participant is dissatisfied with the outcome, the issue will then be taken to the
Executive Director of The NW Network, who will problem solve and work to resolve
the issue. If the issue is still not resolved satisfactorily it may be brought to the Chair of
the Board of Directors of the NW Network, who will then bring it to the Board of
Directors for discussion and resolution. Participants will be notified of this policy while
informed of participant rights. This policy will be posted in the agency & included in
the Participant Packet.
Agreement for Participation: I understand that I when I am representing OutSpoken I am expected to be respectful with other panelists, staff and facilitators. In exchange for my participation, the Northwest Network will compensate me for my time unless otherwise agreed upon. I understand I have right to exit the program whenever I see fit. *
Required
Please type your name below as a digital signature *
Your answer
Date of Signature *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service