Beloved Community Learning Journey Application Form
Please complete this brief application form to express your interest in participating in the launch of one of our three Beloved Community in Action Learning Journeys.   These Learning Journeys will allow small cohorts of learners to join a 2.5 hour workshop, followed by a series of six 90-minute monthly discussions between November 2021 and May 2022.
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First Name *
Last Name *
Email Address *
Cell/Mobile Phone Number (000-000-0000) *
Please select the Learning Journey you would like to participate in. *
What would you like to take away from this Learning Journey as an individual and for your community? *
What would you like to contribute to this Learning Journey as an individual and from your community? *
Are you participating as an individual or with a team (maximum 3 members per team)? *
If you intend to participate with a team of up to three people, please provide the names (first/last) of your other team members.
Language Justice
Please Note: Depending on Language Justice requests for this cohort, we will provide interpretation services for the launch of the Learning Journey during the National Community Leadership Summit; we will then partner with registrants to design a Language Justice approach to the subsequent workshops within the Learning Journey.
Spanish interpretation will be provided during the event for more equitable access to community members. Please select if you would like to utilize Spanish Interpretation:
If selected to participate in a Learning Journey, I agree to attend the launch session in October 2021 as well as the 6 subsequent workshop sessions held between November 2021 and May 2022.  Please type your name, to be used as your electronic signature below. *
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