SJTI Professional Institute Application - June 2018
First Name *
Your answer
Last Name *
Your answer
Position/Title *
Your answer
Describe your responsibilities *
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Institution or place of work *
Your answer
Work Address *
Snail mail address
Your answer
City *
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State *
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Zip Code *
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Cell Phone *
Phone number must follow the following format: xxx-xxx-xxxx.
Your answer
Work Phone
Phone number must follow the following format: xxx-xxx-xxxx.
Your answer
Work Fax
Phone number must follow the following format: xxx-xxx-xxxx.
Your answer
Work E-mail *
Your answer
Have you applied to SJTI before? *
If you've applied to SJTI before, were you placed on the wait list?
If you've applied to SJTI before, were you accepted and deferred?
Is anyone else applying from your institution?
If you answered yes to the question above, please list names
Your answer
Scholarships
SJTI offers a limited number of $100.00 scholarships that will be used to offset the cost of the institute. To learn more, go to: http://www.sjti.org/scholarships.html (link will open in a new window)
Would you like to be considered for a $100 need-based scholarship?
If you answered yes to the question above, why?
Your answer
Social Identities
How do you identify Racially/Ethnically? *
If biracial/multiracial, please note that and then include all racial groups that comprise your heritage
Your answer
Sex Assigned at Birth? *
Your answer
Current Gender Identity? *
Your answer
Age? *
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Sexual Orientation? *
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Religion/Spirituality? *
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Socioeconomic Class of Origin? *
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Nationality? *
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Ability/Disability? *
Your answer
List any other social identity group memberships that you feel are relevant to your work as a diversity trainer or practitioner on issues of race & racism
Your answer
Short Answer Questions
Describe your experience as a trainer of diversity seminars or practitioner exploring issues of race & racism (how long; target populations; general formats for sessions; etc.): *
Your answer
Describe your understanding of race dynamics in your organization and/or in society today: *
Your answer
Write about the areas you need some work on and/or issues you bump into as a trainer or practitioner on issues of race & racism. Also, comment on the skills and competencies you hope to learn during the institute: *
Your answer
How did you hear about SJTI?
Please list specific names and institutions/organizations
Your answer
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