Community ACT Institute Registration | Fall 2023

Join us virtually from 4:30pm-6:30pm, Tues, October 10th through Mon, October 23rd (dates shifted to honor Indigenous People's Day), for our Fall ACT Institute. Participants ages 13-18 engage in activities and exercises focused on an increased understanding of themselves and their world.
We explore complex and necessary topics such as: culture, influence/bias, stress, place, identity, oppression, conflict management, and art activation. All while earning a stipend up to $225!
Please note that filling out this form does not guarantee you a spot in the intensive. We work on a first come, first serve basis while also taking into consideration our racial parity (50% BIPOC participants in all of our programs). You will receive an email soon if your registration has been accepted!

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* 1. Youth Participant Information

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* 2. Parent or Guardian Information

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* 3. How did you hear about ACT?

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* 4. Participants will need to commit to attending the workshops for the full duration. 100% completion and attendance of the workshop is required to receive a full stipend. Will you be able to commit to the dates and times of this workshop? If not, please list your conflicts below.

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* 5. Have you participated in ACT before?

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* 6. If you answered yes to the above question, do you have any of your materials leftover from previous institutes? (Ex: Canvas, USB mic, headphones, etc.)

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* 7. How do you identify racially? (Please choose all that apply)

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* 8. How do you identify ethnically (Ethnicity often refers to the places and cultures that you identify with). Please self-identify. (Non-Exhaustive Examples: African American, Anglo, Chicano/Chicana, French, Mixed Ethnicity, Mixed European Decent, Puerto Rican, Yoruba, etc)

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* 9. What's your national origin? (Please name the country where you were born or share additional comments)

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* 10. What is your gender identity (How would you define your own gender)? (Please choose all that apply)

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* 11. What are your pronouns? (Please choose all that apply)

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* 12. What is your sexual orientation? (Please choose all that apply)

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* 13. What is your first language?

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* 14. What is your (family) class position? (Class often refers to the position someone holds based on their income.)

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* 15. How do you identify related to ability and access? We recognize the terms below are not a complete reflection of the diversity in experience of ability and accessibility. Nor does it capture the variation in needs for accommodations if you do not see an identifier that represents you, please self identify in the area provided.

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* 16. What is your Religious/Spiritual Affiliation?

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* 17. Art

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* 18. Passion

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* 19. Is there anything else that you would like us to know (questions, comments, or concerns)?

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