Spring 2019 Thousand Currents Academy Application

Details on the Academy, including eligibility, here: http://thousandcurrents.org/academy/

Applications are accepted on a rolling basis, with a final deadline of December 1st, 2018

PERSONAL INFORMATION

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1. Applicant Name (Required.)

Last name:

First name:

Preferred name (if different):

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2. Organizational affiliation (Required.)

Organization

Role

(Optional) Secondary organizational affiliation

(Optional) Secondary organizational affiliation role

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3. What is your gender identity? (Ex: woman, genderqueer, man).

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4. Preferred Pronoun(s) (Required.)

She

They

Other (please specify)

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5. What is your age?

18-20

21-29

30-39

40-49

50-59

60 or older

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6. What is your ethnic and/or racial background? (Ex: Black, mixed Chinese and white, South Asian).

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7. Personal Contact Information (Required.)

Personal Address: *

Personal Address 2:

Personal City/Town: *

Personal State: *

Personal ZIP: *

Personal Email: *

Personal Phone: *

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8. Work Contact Information

Work Address:

Work Address 2:

Work City/Town:

Work State:

Work ZIP:

Work Email:

Work Phone:

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9. Email & Phone - Preferred for Communication (Required.)

Personal

Work

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10. Mailing Address - Preferred for Communication (Required.)

Personal

Work

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11. Emergency Contact

Name:

Relation to You:

Phone:

Language Skills

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12. Language

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13. Proficiency

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14. Language

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15. Proficiency

REFLECTION

Brief Responses (100-250 words each)

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16. How were you informed of the Thousand Currents Academy? (Required.)

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17. Why do you want to attend the Thousand Currents Academy? Please include any thoughts on what questions you are holding; what behavior or practice are you seeking to shift in yourself, your institution, and/or the philanthropic sector; what insights or answers are you hoping the Academy will provide. (Required.)

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18. Please include your brief bio (150 words) here and a photo below (JPG, high resolution) for the Thousand Currents Academy Orientation Guide, which we send to all participants in the weeks prior to the Academy. If you would prefer to not share your photo and/or bio with other participants, please note that here and we will take care not publish or share it beyond Thousand Currents staff and faculty; however please still include here for our internal purposes of knowing a bit more about who you are! (Required.)

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19. Upload your photo here.

ACCOMMODATIONS, PREFERENCES & NEEDS

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20. Dietary Restrictions: Please let us know any special considerations we should be aware of when arranging your meals and specify if they are allergy-related, religious or cultural practices, or other personal dietary choices.

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21. Accommodations: Please let us know any special considerations we should be aware of when arranging your sleeping quarters, activity spaces, and curriculum materials. This includes needs related to vision and hearing, mobility, and any other ability or health related requirements. This also includes family needs like on-site childcare.
Note: Accommodations are shared, 2-4 people in a room.

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22. Do you have roommate preferences in terms of similar gender or other identities? Please specify below. (Required.)

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23. What fee range do you anticipate you will fall in, if accepted to the Academy?

We ask so we can anticipate costs and revenue, to do our best to ensure as many participants as possible who need subsidized fees or payment plans can access them.

Please refer to http://thousandcurrents.org/academy/apply/ for guidance on which fee range is appropriate for you. (Required.)

I anticipate paying in the Full-cost fee range ($2,000-$3,000)

I anticipate paying the Subsidized fee range ($1,500-$2,000)

I anticipate paying in the Solidarity fee range ($3,000-$5,000)

I anticipate a lump sum of $1,500 being a barrier to my participation. Please contact me about payment plans.

Please specify details about what would help make the Academy financially accessible to you. For example, "I could pay $1,500 in 4 installments over the course of 6 months." The more information we have, the more we can do our best to work with you to make the Academy affordable.

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* 1. Applicant Name (Required.)

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* 2. Organizational affiliation (Required.)

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* 3. What is your gender identity? (Ex: woman, genderqueer, man).

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* 4. Preferred Pronoun(s) (Required.)

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* 5. What is your age?

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* 6. What is your ethnic and/or racial background? (Ex: Black, mixed Chinese and white, South Asian).

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* 7. Personal Contact Information (Required.)

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* 8. Work Contact Information

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* 9. Email & Phone - Preferred for Communication (Required.)

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* 10. Mailing Address - Preferred for Communication (Required.)

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* 11. Emergency Contact

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* 12. Language

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* 13. Proficiency

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* 14. Language

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* 15. Proficiency

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* 16. How were you informed of the Thousand Currents Academy? (Required.)

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* 19. Upload your photo here.

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* 20. Dietary Restrictions: Please let us know any special considerations we should be aware of when arranging your meals and specify if they are allergy-related, religious or cultural practices, or other personal dietary choices.

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* 22. Do you have roommate preferences in terms of similar gender or other identities? Please specify below. (Required.)

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1. Applicant Name (Required.)

2. Organizational affiliation (Required.)

3. What is your gender identity? (Ex: woman, genderqueer, man).

4. Preferred Pronoun(s) (Required.)

5. What is your age?

6. What is your ethnic and/or racial background? (Ex: Black, mixed Chinese and white, South Asian).

7. Personal Contact Information (Required.)

8. Work Contact Information

9. Email & Phone - Preferred for Communication (Required.)

10. Mailing Address - Preferred for Communication (Required.)

11. Emergency Contact

12. Language

13. Proficiency

14. Language

15. Proficiency

16. How were you informed of the Thousand Currents Academy? (Required.)

19. Upload your photo here.

20. Dietary Restrictions: Please let us know any special considerations we should be aware of when arranging your meals and specify if they are allergy-related, religious or cultural practices, or other personal dietary choices.

22. Do you have roommate preferences in terms of similar gender or other identities? Please specify below. (Required.)