The Circle Series Panelist Application

Question Title

* 1. Please provide your First & Last name.

Question Title

* 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.

Question Title

* 3. What gender do you identify with?

Female

Male

Please indicate other gender you may identify with.

Question Title

* 4. How old are you?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Question Title

* 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

Question Title

* 6. At what email address would you like to be contacted?

Question Title

* 7. What phone number is best to reach you at?

Question Title

* 8. What social media platforms do you use?

Facebook

Twitter

Instagram

Tik Tok

Youtube

None of the above

List your social media handles here

The Circle Series Panelist Application

Question Title

* 1. Please provide your First & Last name.

Question Title

* 2. Please enter your race/ethnicity/country/culture/tribe you identify with.

Question Title

* 3. What gender do you identify with?

Question Title

* 4. How old are you?

Question Title

* 5. Are you familiar with restorative practices and principles like the 'Circle' practice?

Question Title

* 6. At what email address would you like to be contacted?

Question Title

* 7. What phone number is best to reach you at?

Question Title

* 8. What social media platforms do you use?

Question Title

* 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?

Question Title

* 10. Please rate your 'Circle Series' experience thus far?