Name
Best phone number to reach you
Mailing Address
City
State
Zip Code
Email Address
Organization
Personal Information Please answer these questions as you are comfortable--- we want the program to reflect a range of identities and experiences, so this information helps us get a sense of who you are.
Race and Ethnicity
Gender
Economic Class
Sexuality
Disabilities
Age
Languages Spoken/Preferred
Other important things about your identities/life situation?
Will you need ASL interpretation, childcare, visual or auditory aids, wheelchair accessibility, or any other accommodations to participate in the workshop?
Tell us about yourself... The following are questions to let us know where you’re coming from. This isn’t a test, but will help us get to know you. Please write about a paragraph for each question (around 300 words).
Experience: Please describe in some detail your grassroots social justice activism experience during the last few years.
Vision
What motivates you to do the political work you do?
Who is an antiracist role model for you and why?
Goals
Why do you want to participate in the Braden Program?
What will you bring to the program? (Skills, strengths, experiences, etc).
Where do you see yourself applying the lessons and experience of the Braden Program? (Please be as specific as you can about location, communities, organizations, and/or work that you are or plan to be a part of)
Expectations of Participants (in terms of time and money)
Will you be able to make a commitment of an average of 15 hours a week in Braden Program related work for the full course of the program (including the workshop sessions, readings, volunteer placement, grassroots fundraising, meeting with mentor)?
Yes No
All participants will be expected to attend all of the 4-hour workshop sessions, held Sunday afternoons/evenings and a few Saturdays, and only miss a maximum of two sessions. Will you have any conflicts with the Sunday and Saturday sessions?
Yes No
If yes, please give dates
The program begins with a two-day opening session held on a Saturday and Sunday and a two-day closing session also held on a Saturday and Sunday. Will you be able to attend these?
Yes No
All participants are expected to meet with a mentor, who we will pair you up with, at least 3 times over the course of the program. Will you be able to do this?
Yes No
Participants are assigned a volunteer placement with a racial & economic justice organization. Placements range from 4-8 hrs/wk. You will be responsible for transportation. Will you be able to do a 4-8 hour weekly volunteer placement?
Yes No
All participants will be expected to do an average of 30 pages of weekly reading and complete other projects for the program. Will you be able to do this?
Yes No
If No, What will you need to be able to access the readings content?
Grassroots Fundraising
All participants will have the opportunity to develop grassroots fundraising skills and will be asked to help raise money to cover to cost of the Braden Program. Are you willing to participate in grassroots fundraising for the Braden Program?
Yes No
Each participants’ share of expenses is $500-$1000, sliding scale. These fees help raise part of the program budget, (trainings, volunteer placements, room rental, materials, speakers, readers and much more). Will you be able to do this?
Yes No
Catalyst Project prioritizes developing working class leadership, and we have created the Carl Braden Scholarship for Working Class Activists that we can offer to a limited number of participants.
This is about solidarity to build our movement with vibrant working class leadership, so let us know if you would need part or all of the workshop fee covered by the scholarship.
Challenges: Look over the expectations for the program. What do you see as potential challenges for you? (In terms of health, work, family, accessibility needs, etc).
Given the expectations of the program, are there ways the organizers can help make this more accessible to you? Are there ways you get support from friends, family and people in your community to help overcome any of these challenges?
Other
How did you hear about the Braden program?
Anything else you want us to know about you? (Personally, politically, etc).
I am paying my nonrefundable $10 application processing fee right now on the website (using the donate now button) using a credit or check card.
Yes No
I am sending my nonrefundable $10 application processing fee as a check/money order by October 1, 2010.
Yes No
Thank you for your time and interest in Catalyst Project’s Anne Braden Program! We will be getting in touch with you about your application mid-November, 2010.
