Intergroup Dialogues @ Peralta Interest Form

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Thank you for your interest Intergroup Dialogues Initiative 2021-2022

Fill out this form to:
1. Express your interest for the Intergroup Dialogues and/or the 12-hour Experiential Workshop OR
2. Request more information about the IGD Workshop before signing up OR
3. Decline Fall 2021 participation but be contacted regarding any future workshops, if offered in an upcoming semester.

Information from this form will be used solely for the purpose of coordinating Intergroup Dialogues at Peralta by the PFT Subcommittee on Antiracism and Intersectionality in 2021-2022 and will be kept private.

Email *

First Name *

Last Name *

Preferred Contact Phone *

At which site(s) do you currently work? *

Berkeley City College

College of Alameda

Laney College

Merritt College

District Office

Required

Would you like to register for the 12-hour Intergroup Dialogues Workshop planned for Fall 2021? *

Yes! I can commit to the full 12-hour training, please register me for the workshop. (We will contact you to request final confirmation).

Maybe. I would like to request more information before I sign up. (We will email you more information and can arrange to talk with you, if desired).

Not yet. I cannot participate in the Fall 2021 workshop, but please notify me in the future.

Please skip this question if you did NOT attend the 12-hour Intergroup Dialogue Experiential Workshop in Spring 2021. After having participated in the Spring 2021 12-hour IGD Workshop, are you interested in attending any of these events (mark all that apply):

60-90 minute session or sessions with the co-facilitators to begin deepening of the Intergroup Dialogues experience

A true Intergroup Dialogue session in small, co-facilitated group

Attend the 12-hour experiential workshop for a second time in Fall 2021

Join the PFT Diversity Subcommittee to plan and support these and more events upcoming for Intergroup Dialogues

Please provide your feedback about your interest (either growing or waning) for the Intergroup Dialogues.

By completing this form, I am expressing interest in in the Intergroup Dialogues Experiential Workshop and Intergroup Dialogues Session planned for 2021-2022. I understand that space is limited and participants may be waitlisted if needed. *

I understand and agree with this statement.

Required

A copy of your responses will be emailed to the address you provided.

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