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* 1. FULL NAME (First and Last)

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* 2. EMAIL

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* 3. CLASS YEAR

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* 4. ACADEMIC MAJOR(S)/MINOR(S)

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* 5. How do you self-identify in terms of RACE/ETHNICITY?

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* 6. How do you self-identify in terms of GENDER?

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* 7. Please rank your TWO MOST PREFERRED DIALOGUE TOPICS (i.e., the dialogues in which you would be most interested to participate). (NOTE: Final dialogue placement will be determined by the program, and will be based on interest and peer-facilitator availability. Please also consider which dialogues are appropriate, based on your racial identity.)

  PEOPLE OF COLOR/WHITE PEOPLE Intergroup MULTIRACIAL IDENTITY Intragroup (for self-identified bi-/multiracial students) PEOPLE OF COLOR Intragroup (for self-identified students of color WHITE RACIAL IDENTITY Intragroup (for white-identified students)
FIRST choice
SECOND choice

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* 8. Please explain briefly why you prioritized the dialogue topics as you did (2-3 sentences will suffice).

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* 9. Please write a brief essay (250 words or less) explaining: (1) why you're interested in enrolling in an IGR dialogue; and (2) what you hope to gain from this experience.

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* 10. How did you hear about the inter-/intragroup dialogues on race? (select all that apply)

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