Application for Friday Friends Caswell Community Dialogues

Please read carefully

WLI and the Caswell Chapter of The Health Collaborative (CCTHC) have worked together to create a unique opportunity for Caswell’s leaders, a 4-month Community Dialogue experience rooted in the Friday Fellowship principles and practice. Community Dialogues are 2 hour sessions with an additional hour is set aside at each session for a shared meal. (optional).

This unique opportunity has been created for courageous leaders from Caswell County who demonstrate the values of integrity, intention, and inclusion.

The first Friday Friends Caswell Community Dialogue Cohort will meet at 6pm on the following dates at the Yanceyville Municipal Building. Dinner will be available from 5-6pm.

Tuesday, May 14
Tuesday, June 11
Wednesday, July 10
Tuesday, August 13

Participants MUST COMMIT to attending all four sessions.

If you would like to participate, but are unable to commit to the four initial sessions, please note that on your application and share your most flexible times to inform us in the planning of future cohorts.

Applications Due Wednesday, April 10.

Question Title

* 1. Please tell us who you are

Question Title

* 2. Email Address

Question Title

* 3. Phone number

Question Title

* 4. Address

Question Title

* 5. Are you able to commit to attending all four sessions of this first cohort?

Yes

Question Title

* 6. Please tell us why you would like to join this first Friday Friends Caswell Community Dialogue. What do you hope to gain from the experience?

To help us ensure a diverse group of folks in this first cohort, please give us a better idea of your lived experiences, ideologies, and identities. This information will not be shared beyond Shannon Moretz and the Friday Friends facilitators from Wildacres Leadership Initiative.

Question Title

* 7. Your Gender Identity

Female

Male

Transgender

Non-binary

Other (please specify)

Question Title

* 8. Your Racial Identity

American Indian or Alaska Native

Asian

Black of African American

Native Hawaiian or Other Pacific Islander

White

Question Title

* 9. Your Ethnicity

Hispanic

Non-Hispanic

Question Title

* 10. Your Political Affiliation

Democrat

Republican

Libertarian

Green Party

Constitution Party

Natural Law Party

Unaffiliated

Question Title

* 11. Your Sexuality

Asexual

Bisexual

Gay/Lesbian/Homosexual

Straight/Heterosexual

Queer

Other (please specify)

Question Title

* 12. Highest Educational Level

Never Completed High School

High School Diploma or GED

Some college

Technical or Professional Certification

Undergraduate Degree

Graduate Degree

Question Title

* 13. Your Age

18-24

25-34

35-44

45-54

55-64

65+

Question Title

* 14. Do you have any dietary restrictions? (For meal planning purposes)

Thank you for applying. Individuals selected to participate in this first Friday Friends Caswell Community Dialogue will be notified by Monday, April 15.