The Circle Series Panelist Application
1.
Please provide your First & Last name.
2.
Please enter your race/ethnicity/country/culture/tribe you identify with.
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Another race
Please also specify the country/culture/tribe you identify with.
3.
What gender do you identify with?
Female
Male
Please indicate other gender you may identify with.
4.
How old are you?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
5.
Are you familiar with restorative practices and principles like the 'Circle' practice?
Extremely familiar
Very familiar
Somewhat familiar
Not so familiar
Not at all familiar
6.
At what email address would you like to be contacted?
7.
What phone number is best to reach you at?
8.
What social media platforms do you use?
Facebook
Twitter
Instagram
Tik Tok
Youtube
None of the above
List your social media handles here
9.
Tell us why you want to be a panelist on the 'Circle Series' and what you have to share with African diaspora our audience?
10.
Please rate your 'Circle Series' experience thus far?
1 star
2 stars
3 stars
4 stars
5 stars
Current Progress,
0 of 10 answered
