Family and Culture: Panelist Application
If you are interested in volunteering to be a panelist, please fill out this short application by midnight Monday, July 10. We will be using this to determine who will be on the panel in order ensure that a diversity of voices and experiences are represented.

The three questions at the end of this application will be asked during the panel. Afterwards, we will open up the panel to audience questions related to the topics of family and culture. If you are chosen, you will be sent more information through email about what to expect.

Furthermore, please contact us at wopac.roots@gmail.com if you would like to be a dialogue moderator in addition to or instead of being a panelist. We will schedule a short phone/Skype call with you to give you more information.

Deadline: 11:59 PM Monday, July 10
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EVENT INFORMATION
Date: Sunday, July 17
Time: 1:30 p.m.-4:30 p.m.
Location: Mitchell Park Community Center - El Palo Alto Room

Name *
Your answer
Email *
Your answer
Age
Your answer
Local High School Affiliation and Graduation Year
(If applicable, i.e. Paly '13, Gunn parent, etc.)
Your answer
Current Occupation
Your answer
Within my family, I am a...
Check all that applies
What cultures/cultural communities do you identify with?
Could be based on ethnicity and race, immigration status, language, gender and sexuality, religion, etc.
Your answer
Why do you want to be a panelist? *
Your answer
What are some of the challenges you face in communicating with your family? *
Your answer
How is your family dynamic shaped by culture? *
Your answer
How have your family and cultural identities impacted the way you interact with others outside of your family? *
Your answer
I'm interested in being a small group dialogue moderator!
Please contact us at wopac.roots@gmail.com to schedule for a phone or Skype call.
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