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 13-15, 2017 @ 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.

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

2. Name on UCR ID Card:

3. Email address:

4. Please re-enter email address:

5. Cell phone number:

6. Year in school starting Fall 2017:

7. Will you be attending UCR campus classes for the entire 2017-18 academic year?

8. Is your cumulative GPA 2.5 or higher?

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

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

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

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

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

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.

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

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.

17. What is your T-shirt size?

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