Thank you for registering for the 2019 Sustained Dialogue Summer Leaders' Summit! Please fill out this short survey with your information. We look forward to meeting you!

Contact Rhonda at rhonda@sustaineddialogue.org with any questions or concerns.

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* 1. First and Last Name (as you would want it to appear on your nametag)

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* 2. What is your email address? (gmail or personal email preferred)

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* 3. What is your cell phone number?

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* 4. What college, university, or organization are you affiliated with?

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* 5. If you are a student, what is your expected graduation year?
If you are an advisor, administrator, faculty, or staff, what is your title/position?

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* 6. What is your involvement with SD to date and what do you anticipate your role with SD to be in the upcoming school year (student leader, participant, moderator, initiator, advisor, champion, etc.)?

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* 7. Please describe any dietary restrictions or allergies.

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* 8. Please describe any relevant needs or medical/physical conditions that would help us plan our activities.

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* 9. If you are staying in a shared room overnight in George Washington University Summer Housing, you may be in a room with several bunk beds and one bathroom. Please indicate any special needs that might relate to this set-up.

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* 10. If you are not staying at GW for your lodging (which you signed up for and paid for on the main registration site), you will need to arrange your own independent lodging.

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* 11. The dorm rooms are GW will be divided by gender (and by students/advisors). If this don't work easily for you, please let us know so we can work out a great solution

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* 12. If you know your travel arrangements for getting to and from DC, please specify those below (DATES when you arrive, flight times, which airport you will be getting in to, arrival times and dates if driving, etc.). If you have not yet made your arrangements, please let us know when you do by emailing rhonda@sustaineddialogue.org or you may not receive housing properly.

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* 13. I give SDCN permission to use pictures or video clips of me from the Summit in future communications (website, newsletters, YouTube, etc.).

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* 14. Please provide any comments that would better help us understand your responses to the above questions, or anything else you would like us to know. Thank you for your time and responses!

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* 15. Preferred T-shirt size from following choices: S, M, L, XL, XXL (not guaranteed, especially if you fill this out late)

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* 16. (Optional) Are you (alone or in a group other than SD) doing organizing work to improve society that you might want to share at SLS?

Depending on your willingness to bring your work to others in this group, we are looking for students or advisors who may have something to share in the following areas.

Climate/Environment, Policing/Justice system, Health outcomes, Housing/Homelessness/Transportation, Public Policy, K-12 Education, Employment/Hiring, Violence reduction, Poverty Alleviation, or another area.

Please describe your work below if there is something that you're up to!

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