BD101 Educators - APPLICATION

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BD101 Educators - APPLICATION - July 2024

Hello -

Thank you for your interest in Beyond Diversity 101 Educators. This short application helps us ensure we have a balanced group of participants.

Any applications received by April 20th will be reviewed and participants notified by May 3rd. We will continue to fill spots after May 3rd and will maintain a wait-list. If your plans change, please let us know as soon as possible.

Thank you,

varun & Lisa

Email *

1. Please provide your full name: *

2. Cell phone or best contact phone number *

3. What led you to apply for this workshop? What do you hope to get out of attending? (~50 word answer) *

4. What age group(s) do you work with and in what context(s)? (ex. 4th grade teacher in a private school, young adults aging out of foster care in a state program, etc.)

5. In which decade of life are you?

20's

30's

40's

50's

60's

70's

80's

90's

Clear selection

6. What is your race and/or ethnicity?

7. What is your gender? (we use this for both balancing the group and for rooming assignments for those who choose to share a room)

8. We want to have a balanced group in terms of various social identities. Please share any other identities that are important to you and your practice as an educator.

9. If you are choosing a double or triple rooming option, what genders are you comfortable sharing a room with? Is there someone else attending with whom you would like to share a room?

CHANGE THIS ABOUT PHYSICAL ACCESS

11. Do you have any allergies or dietary restrictions?

12. Please provide the name and cell number of an emergency contact:

Any additional information or questions?

Submit

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