Application for Cross Class Dialogue Circle
SUBMIT BY MAR 6th 2015. We will get back to you by MAR 9th 2015.
The following information will help the facilitators to understand more about what you would bring to the dialogue group: your goals and concerns, your experiences, your learning needs, and anything else you think we should know. We will use the information to ensure we have a diverse and committed group of participants, and to plan dialogue sessions that will work for this specific group. All information will be kept confidential and not shared with anyone besides the two facilitators. If you prefer to talk through the application instead of writing it - call Angela at 254-3400.
What is your name?
Your answer
What is your phone #?
Your answer
What is your email address?
Your answer
What is the best way to reach you?
What inspires you to sign up for this cross-class dialogue?
Your answer
What do you hope to learn/gain from your participation in the dialogue?
Your answer
What are some of your concerns about participating in the dialogue?
Your answer
What other learning experiences have you had that you think might be relevant to this dialogue?
either specifically about class or about related systems of oppression
Please briefly describe your class background and current class situation, in your own words.
Your answer
Please provide the following demographic information: Age, Gender, Race, Ethnicity, Sexual Orientation, and Any other identity that you want to share (optional)
Your answer
Do you have any access needs we should know about (e.g. mobility considerations, large print handouts, …)?
e.g. mobility considerations, large print handouts, ...
Your answer
Because the dialogue involves building trust in the group over time, a commitment to participate in every session is very important. Please mark the sessions you will be able to attend.
Is there anything else you'd like to share?
Your answer
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