2009 Winter Student Retreat (Snow Camp) Application

The Winter Student Retreat brings UCR students together for "Community Building Through a Social Justice Lens." We will explore what brings us together within the LGBT community, as well as how our different experiences and identities create spaces for ally-building and activism.

If selected to participate, you will also need to complete a Liability Waiver and Emergency Contact Form. We require a $50 deposit check (payable to "QA") that will be returned to you when you get on the bus Friday, January 9, 2008. The check will be donated to Queer Alliance if you do not show up for the Retreat.

1. Full Name

Full Name

2. Preferred Name (for Name Tag)

Preferred Name (for Name Tag)

3. Student ID number

Student ID number

4. E-mail address

E-mail address

5. Cell phone number

Cell phone number

6. Year in school

Year in school 1st

2nd

3rd

4th

5th+

Grad

7. Meal preference

Meal preference Vegetarian

Vegan

Meat-eater

8. List any food allergies.

List any food allergies.

9. Do you have any ADA-related issues to report? Please share needed accommodations for physical disabilities with this application.

Do you have any ADA-related issues to report? Please share needed accommodations for physical disabilities with this application.

10. Please describe your involvement within the LGBT and Allies community (e.g. student organizations, panels, tabling, UCLGBTIA or conference participation, Stonewall Hall, Allies Program, Peer Connections, Tuesday Rap Groups, high school involvement or QA Youth Outreach, Coming Out Monologues, Drag Ball...).

Please describe your involvement within the LGBT and Allies community (e.g. student organizations, panels, tabling, UCLGBTIA or conference participation, Stonewall Hall, Allies Program, Peer Connections, Tuesday Rap Groups, high school involvement or QA Youth Outreach, Coming Out Monologues, Drag Ball...).

11. Please share in the space below why you wish to attend the 2009 Winter Student (Snow Camp) Retreat.

Please share in the space below why you wish to attend the 2009 Winter Student (Snow Camp) Retreat.

12. In order to create the best possible Snow Camp Winter Retreat for all, we wish to gather more information about your identities.

Please write a paragraph describing how you identify yourself (i.e. how to you identify your race, sexual orientation, gender, religion, ability, etc.?). It’s okay to list that you don’t know an identity or choose not to identify a particular identity.

In order to create the best possible Snow Camp Winter Retreat for all, we wish to gather more information about your identities. Please write a paragraph describing how you identify yourself (i.e. how to you identify your race, sexual orientation, gender, religion, ability, etc.?). It’s okay to list that you don’t know an identity or choose not to identify a particular identity.