Registration: Systemic Racism and The Legacy Of Education: 6/26 - 7/24 2017
This registration page is for the upcoming course Systemic Racism and the Legacy of Education which will commence 5 Mondays 6/26 - 7/24 2017 6:30 - 8:30 pm in Cambridge near Harvard Square. This form is step one of the two-step registration requirements for all participants of the 5-week course. To complete both steps you must complete this form and reserve your spot by purchasing your tickets at Eventbrite and forward your ticket to antiracismcollab@gmail.com.

The results of this form will remain confidential and is used solely to support your access to the right facilities and program content. Our facilitation team uses these results, in confidence, to create the optimum program for your needs via sharing important information with the facilitators who will be working directly with you. Once both steps are complete, you will be supplied a syllabus for the course and an introductory readings from one of the facilitators.

We are excited for your interest in the course and encourage you to direct any additional questions you may have to antiracismcollab@gmail.com.

What do you hope to gain from this training experience? (please be specific)
Your answer
Do you have a sense about the challenges you face around prejudice or racism? Please describe to the degree that you are comfortable doing so.
Your answer
In addition to this workshop series, what other types of experiences have you had learning about diversity or racial justice?
It is suggested that this is not be your first training in racial awareness or activism.
Your answer
What pronoun do you prefer to identify your gender identity?
While this question is not mandatory, it helps us understand who is attracted to and attending our courses and how to support all learning styles and create as safe a class as possible.
Your answer
How would you characterize the role of socially inflicted trauma in your life?
While this question is not mandatory, it helps us understand who is attracted to and attending our courses and how to support all learning styles and create as safe a class as possible.
Your answer
How do you identify generationally?
While this question is not mandatory, it helps us understand who is attracted to and attending our courses and how to support all learning styles and create as safe a class as possible.
Your answer
How do you identify racially?
While this question is not mandatory, it helps us understand who is attracted and attending our courses and how to support all learning styles. Additionally it will help us frame whether or not we will implement affinity based course work.
Your answer
How do you identify your class background?
While this question is not mandatory, it helps us understand who is attracted to and attending our courses and how to support all learning styles and create as safe a class as possible.
Your answer
Will you require any support related to accessibility to access materials or the teaching space that you would like us to be aware of?
While this question is not mandatory, it helps us understand who is attracted to and attending our courses and how to support all learning styles and needs so we can create as safe a class as possible. This course is offered in a location that is not wheelchair accessible.
Your answer
Is there any additional information you would like us to know?
Your answer
The information in this survey will be used to aid facilitators to address concerns and prepare for student needs. If you consent, the content of the survey will also be used to understand the demographics of course participants and to aid us in growing more responsive in our commitment to nuanced and sensitive anti-racism trainings. Specify your consent by checking the box below.
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Please enter your email address
Results will be used solely by the facilitator.
Your answer
Please enter your full name.
Results will be used solely by the facilitator.
Your answer
How do you feel about providing film reactions or quotes (anonymous or otherwise) to describe our workshops to future participants?
Details are subject to your comfort level and would require a release.
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If you would like to be kept updated about future training please respond based on your preference.
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