Student SJTI Application - 2018
First Name *
Your answer
Last Name *
Your answer
Preferred Name for Nametag *
Your answer
Mailing Address *
Snail mail address
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
School Email Address *
Please list an email that you check regularly
Your answer
Personal Email Address *
Your answer
Cell Phone *
Phone number must follow the following format: xxx-xxx-xxxx.
Your answer
T-shirt size *
Emergency Contact - First Name *
Your answer
Emergency Contact - Last Name *
Your answer
Emergency Contact Phone *
Phone number must follow the following format: xxx-xxx-xxxx.
Your answer
College/University *
Your answer
Class Standing in Fall 2018 *
Age *
Your answer
SJTI Coach's First Name *
Your answer
SJTI Coach's Last Name *
Your answer
SJTI Coach's Email Address *
Your answer
Dietary Needs: *
What, if any, accommodations will you require to participate fully in the Institute?
Ex: ASL interpreter, assistive/adaptive technology, etc.
Your answer
Are you receiving outside funding or sponsorship? *
Ex: student government funds, grant, etc.
What is your housing preference for the Institute? *
The SSJTI host committee will work diligently to assist in meeting housing preferences; however due to limited space, housing preferences may not be met.
Please tell us about your student involvement and activities, both on- and off-campus. *
Your answer
Socio-Cultural Identities
It is important to us that we select a diverse group of participants. Please share with us your identities in the following socio-cultural identity groups:
How do you identify Racially/Ethnically? *
If biracial/multiracial, please include all racial groups that comprise your heritage
Your answer
Gender Identity *
Your answer
Sexual Orientation *
Your answer
Socioeconomic Status (SES) *
Your answer
Nationality *
Your answer
Ability/Disability *
Your answer
Religion/Spirituality *
Your answer
Any other socio-cultural identity group membership you feel is relevant? *
Your answer
How did you hear about SJTI: The Student Experience? *
Your answer
Short Answer Questions
Why do you want to attend SJTI: The Student Experience? *
Your answer
What kinds of experiences have you had that have helped you to understand diversity and social justice? *
Your answer
In what areas of diversity and social justice do you feel you most need to grow and learn? *
Your answer
How would you like to apply what you learn when you return to your home and college/university communities? *
Your answer
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This form was created inside of Social Justice Training Institute.