ED&I Action Plan- Implementors Application

This application form is for prospective implementors who would like to participate in communities of practice around implementing the Equity, Diversity, and Inclusion Action Plan. Each implementation group will have 5-8 implementors that meet monthly for 90 minutes from May 2021- May 2022.

We ask that UCEDD Directors complete this form in collaboration with the prospective implementor. If you have any questions, please contact Katie Johnson (kjohnson@aucd.org). The deadline to apply is April 19th at 11:59pm ET.

Note: UCEDD Directors are welcome to apply as implementors themselves. If UCEDD Directors are applying as implementors, please skip the UCEDD Director letter of support, and just submit the statement of interest.

Question Title

* 1. Name of UCEDD Director providing support for this application

Question Title

* 2. Prospective Implementor's Contact Information (Implementors will be sent a physical copy of the ED&I Action Plan, so address needs to be somewhere they can recieve mail)

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number

Question Title

* 3. Which action steps of the ED&I Action Plan is the implementor actively working on where they would benefit from additional technical assistance? (mark all that apply)

CC-1.1

CC-2.1

CC-2.2

CC-2.3

WD-1.1

WD-1.2

WD-1.3

WD-1.4

WD-1.5

WD-2.1

WD-2.2

CLC-1.1

CLC-1.2

CLC-2.1

CLC-2.2

LSI-1.1

LSI-1.2

LSI-2.1

LSI-2.2

LSI-3.1

LSI-3.2

LSI-3.3

Question Title

* 4. In a few sentences, please describe the implementors need for technical assistance around implementing the ED&I Action Plan. (eg. How does the plan relate to their role and current work plan? What specifically could they use assistance with to further implementation?).

Question Title

* 5. Attach the implementor's statement of interest-- one page maximum

PDF, DOC, DOCX file types only.

Choose File

Question Title

* 6. Attach UCEDD Director's letter of support for implementor to commit time and resources to participate in this TA initiative and to implement the ED&I Action Plan at their UCEDD -- one page maximum

PDF, DOC, DOCX file types only.

Choose File