Exit this survey >>
The Common Ground Retreat brings UCR students together for community building through a social justice lens. We will explore what brings us together, as well as how our different experiences and identities can create spaces for ally-building and activism. The retreat will be October 14-16, 2016 @ Camp Pilgrim Pines.

This application is for students who wish to attend the Common Ground Retreat. Be mindful of giving thoughtful responses to the questions below, as the review committee will solely utilize this application to select student participants.

All transportation, housing and meals will be provided free of charge. While the retreat is free to participants, those invited to attend who confirm and then fail to show up for the retreat will have their student account charged $100.

If selected to participate, an email will be sent to you with the paperwork necessary to complete your application. Your completed paperwork (photo release, emergency contact, and liability waiver) will be due by Week 1 of Fall Quarter. If you have any questions, please contact Nancy Tubbs <nancy.tubbs@ucr.edu> 951.827.2267 or Joe Virata <joe.virata@ucr.edu> 951.827.7215.

Question Title

1. Preferred First Name for name tag and contact list:

Question Title

2. Name on UCR ID Card:

Question Title

3. Email address:

Question Title

4. Please re-enter email address:

Question Title

5. Cell phone number:

Question Title

6. Year in school starting Fall 2016:

Question Title

7. Will you be attending UCR campus classes for the entire 2016-17 academic year?

Question Title

8. Is your cumulative GPA 2.5 or higher?

Question Title

9. Have you attended Common Ground Retreat in the past?

Question Title

10. How did you hear about the Common Ground Retreat?

Question Title

11. Please share in the space below why you wish to attend and what you hope to gain from the Common Ground Retreat.

Question Title

12. What does "community" mean to you at UCR?

Question Title

13. Please describe your involvement with any student organizations, community groups, or campus departments.

Question Title

14. In order to create the best possible retreat experience for all, we wish to gather more information about your social identities. The information will help us create diverse discussion groups, and will NOT be used for data gathering or demographic reporting.

Please write a paragraph describing how you identify yourself (i.e. how do you identify your ethnicity, sexual orientation, gender, religion, ability, etc.?). Please write whatever you feel comfortable sharing. Only UCR professional staff will see your answers.

Question Title

15. Please share below any needed ADA-related accommodations.

Question Title

16. Please mark below that you understand the following: The retreat is free to all participants. However, IF you are invited to attend, you confirm, and you fail to show up for the retreat, then your student account will be charged $100.

Question Title

17. What is your T-shirt size?

T