2013-2014 Beloit Sustained Dialogue Participant Application

1. Sustained Dialogue Sign Up Sheet

 
Thank you for your interest in participating in Sustained Dialogue! To sign up, please fill in the survey below. This information is used to place you within a group that best meets your expressed interests within Sustained Dialogue and with people of as many different backgrounds, experiences, and opinions as possible. The following questions are NOT used to exclude anyone from a group, so please be honest and specific. Your answers will be kept confidential and will not be shared with any other participants.
1. First Name
2. Last Name
3. Email Address
4. Residence Hall
5. Expected Graduation Year
6. Hometown and State or Home Country
7. Gender
8. Major/Concentration(s)
9. How did you hear about Sustained Dialogue?
10. Why are you interested in Sustained Dialogue? What do you hope to get out of SD?
11. Which groups or activities are you very involved with on campus?
12. What are 3 potential topics that you would like to address?
13. What are 3 potential topics that you would like to learn more about?
14. What would you identify as your background? (Feel free to describe your race, ethnicity, religious background, ability status, sex and gender, political and/or socioeconomic background)
15. Do you feel that your background plays a role in your everyday life and interactions? If so, how?
16. Do you consider yourself a talker or a listener?
17. What jobs/organizations/activities are you involved in?
18. What, if any, experience do you have talking about identity (race, ethnicity, gender, religion, sexual orientation, ability status, etc.)?
19. One of the key aspects of Sustained Dialogue is the time commitment. Each group member is expected to be present for each weekly, hour and a half meeting of the dialogue group. Can you commit to participating fully as a participant?
Below, please tell us which times you're available. If you have strong preferences about meeting time, please tell us in the Comments box.
20. Please fill in your availability:
MondayTuesdayWednesdayThursday
Before Dinner
During Dinner
After Dinner