"Breaking Silence: An Arts, Action, and Healing Summer Camp" Lottery

Name *

Date of Birth *

Please note you must be 16 years or older to attend camp without a chaperone.

Gender Pronoun *

Please note camp is open to women (transgender, cis-gender, or gender non-conforming)

Race/Ethnicity *

Please note camp is for those who identify as Black/People of Color

Address *

Email *

Cell Phone *

Current City *

Check All That Apply *

Organized an AAPF Town Hall in 2015/2016/2017

Testified in an AAPF Town Hall in 2015/2016/2017

Commissioner for an AAPF Town Hall in 2015/2016/2017

Contextualizer for an AAPF Town Hall in 2015/2016/2017

Future AAPF Town Hall Organizer for 2017/2018

Survivor of State/Police Violence

Family Member of Victim of State/Police Violence

College Student Organizer

Sonstiges:

Pflichtfrage

Have you attended camp in the past? *

Yes- 1 Year

Yes - 2 Years

No - First Time

Which 3 objectives are you MOST interested in gaining from the summer camp? *

Develop tools to heal from past trauma

Gain artistic skills to forward activist work

Commune and network with other women of color

Prepare to organize or testify at a future town hall

Learn about how to activate Family Lead Organizing strategies

Deeper understanding of issues and development of political agenda

Increase my comfort level for public speaking about my experiences with state/police violence

Sonstiges:

Pflichtfrage

Will you need to receive a scholarship to be able to attend the program? *

The cost of room and board is $60/day, totaling $300 for the five days. This covers accommodations in Vassar College dormitories and 3 meals a day.

I only need room and board covered - I can get to Poughkeepsie, NY myself

No scholarship needed

How can camp support you with your current organizing work on issues facing Black Women and Girls? (Be specific)

By writing my name below, I am indicating that I am available to fully participate in the program and be in NY July 19th - July 24th. *

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Dieses Formular wurde bei The African American Policy Forum erstellt. Missbrauch melden