2017 - 2018 NCCPA Equity, Diversity & Inclusion Task Force Application

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Hello and thank you for your interest in serving on the 2017 - 2018 NCCPA Equity Diversity Task Force

Members of the NCCPA Equity Diversity and Inclusion Subcommittee support the Member at Large for Equity and Inclusion in assessing, evaluating and implementing equity, diversity and inclusion practice and function in the North Carolina state chapter of ACPA. The two primary objectives of the Equity, Diversity and Inclusion subcommittee are to:

1. Establish and drive a robust array of services and resources that seek to increase competence and fluency around Equity, Diversity and Inclusion in higher education. This can include but is not limited to blogs, webinars, libraries, symposia and other applied opportunities

2. Increase the membership and engagement of diverse professionals through out NCCPA Leadership, Programming and Activities

Please complete the form below. All applications must be completed by March 31st at 5:00pm. If you have any questions, please contact Mr. Brandon Bell at bellb@uncw.edu or at 910.962.3303.

Prefix

First Name *

Last Name *

Professional Title *

Institution *

Email Address *

Phone Number *

Professional Level *

Vice President of Student Affairs

AVP or Number Two

Senior Level Professional

Mid-Level Professional (5 - 10 years of experience)

New Professional (0 - 5 years of experience)

Doctoral Student

Graduate Student

Undergraduate Student

Gender

Agender

Genderqueer or Non-Binary

Transgender

Man

Woman

Transman or Transmasculine

Transwoman or Transfeminine

Prefer Not to Answer

Other:

Clear selection

Gender Pronouns

She/Her/Hers

He/Him/His

They/Them/Theirs

Ze/Zir/Zirs

Use my name

All pronouns

Other

Clear selection

Race & Ethnicity (Check All that Apply)

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White or Caucasian

Prefer Not to Answer

Are you Hispanic or Latino/a/x

Yes

Clear selection

Sexual Orientation: Do you consider yourself to be:

Bisexual

Gay or Lesibian

Heterosexual or straight

Transgendered

Queer

Other

Clear selection

Are you a part of the Active Military or Have Veteran Status

Yes

Clear selection

Accessibility Needs & Services

Audio

Visual

Mobile

None

Other:

Clear selection

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