Inclusiveness Team Application

Thank you for your interest in the Colorado Coalition Against Sexual Assault (CCASA) Inclusiveness Team. CCASA recognizes that sexual assault and oppression are intricately linked and we are committed to grappling with the complexities of societal power and privilege in order to create inclusive policies and practices. With this idea in mind, CCASA has formed an Inclusiveness Team (IT) to enhance CCASA’s core value of anti-oppression and social justice.

Your responses to the following questions will assist us in getting to know you. Your responses to demographic questions also help us to ensure representation of diverse communities on the IT. However, we do not expect anyone to be “the” representative for any particular identity, rather all team members are responsible for calling attention to when we should seek broader input. Of course, please feel free to skip any question.

Selection Criteria:
• Align with CCASA mission and values
• CCASA member or willingness to become a member
• Geographic diversity
• Experience personally or professionally with grappling with complexities of societal power and privilege
• One year commitment to participating on the Inclusiveness Team

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* 1. Please provide your name and contact info:

Name: *

Company: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Country:

Email Address: *

Phone Number: *

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* 2. Are you either an individual member of CCASA or affiliated with a member agency?

Yes

I don't know

No, but I am willing to become a member

No. Please provide a brief explanation

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* 3. With what type of agency are you affiliated?

Stand-alone sexual assault agency

Dual sexual assault and domestic violence agency

I am not affiliated with an agency

Other (please specify)

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* 4. What category best describes the geographic location of your primary residence? (check all that apply)

Rural

Frontier

Urban

Suburban

Other (please specify)

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* 5. In which geographic region are you located? The following list is how CCASA describes regions in Colorado. Please choose the region that includes the county where you live, even if you don't normally identify with that region.

Northwest (Mesa, Garfield, Rio Blanco, Moffat, Routt, Grand, Clear Creek, Summit, Lake, Pitkin, Eagle)

Southwest (Delta, Montrose, Ouray, San Miguel, Dolores, Montezuma, San Juan, Hinsdale, Gunnison, Saguache, Alamosa, Costilla, Conejos, Rio Grande, Mineral, Archuleta)

Southeast (Park, Teller, Chaffee, Fremont, Custer, El Paso, Crowley, Cheyenne, Kiowa, Prowers, Baca, Bent, Otero, Las Animas, Pueblo, Huerfano)

Northeast (Sedgwick, Phillips, Logan, Weld, Morgan, Washington, Yuma, Kit Carson, Larimer, Jackson)

Central (Boulder, Gilpin, Jefferson, Douglas, Elbert, Lincoln, Arapahoe, Adams, Broomfield, Denver)

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* 6. What is your biological sex?

Female

Intersex

Male

Other (please specify)

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* 7. What is your gender identity? (Check all that apply)

Woman

Man

Transgender

Other (please specify)

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* 8. What is your age?

Under 18

18 - 30

31 - 45

46 - 65

65 - 80

Over 80

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* 9. What is your race/ethnicity? (Check all that apply)

African American/Black

Asian/Pacific Islander

Hispanic/Latino(a)

Native American

White/Caucasian

Other (please specify)

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* 10. What is your sexual orientation? (Check all that apply)

Bisexual

Gay

Lesbian

Heterosexual

Queer

Questioning

Asexual

Other (please specify)

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* 11. Do you have a disability?

Yes

I don't know

If yes, please describe your disability.

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* 12. In what languages do you consider yourself fluent?

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* 13. What is the primary language spoken in your home?

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* 14. In what socioeconomic status do you consider yourself?

Lower class/Poor

Working Class

Middle Class

Upper Class

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* 15. Do you represent a culturally-specific agency?

Yes

I don't know

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* 16. Please select any of the following you identify with:

Primary survivor of sexual assault

Secondary survivor (friend/family of survivor)

Activist

Educator

Student

Community Member

Therapist/clinician

Victim/Survivor Advocate

Other Service Provider (please explain):

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* 17. Is there any other identity that is important to you that we haven't asked about that you would like to share?

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* 18. Why do you want to join the Inclusiveness Team?

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* 19. What do you hope to contribute to the Inclusiveness Team?

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* 20. What is your definition of inclusiveness?

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* 21. In what ways do you see oppression and sexual assault as linked?

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* 22. Are you able to commit to a year or more on the Inclusiveness Team?

Yes

I don't know (please explain)

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* 23. Do you anticipate any challenges with the roles and responsibilities?

Yes

I don't know (please explain)

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* 24. Would you have difficult traveling around the state for quarterly meetings if mileage and lodging were reimbursed?

Yes

I don't know (please explain)

Thank you for your interest in CCASA's Inclusiveness Team.
If you have any questions please contact:
Colorado Coalition Against Sexual Assault
1120 Lincoln St., Suite 700
Denver, CO 80203
director@ccasa.org
303-839-9999