Intensive Workshop Application: Spring 2008


Workshops $20/each

Applicants are reviewed on a first come first serve basis. All applications must be received at least 1 week prior to the session. Space is limited


PERSONAL INFORMATION:
Name:
Home address:
City:
Zip:
Work phone:
Home phone:
Cell phone:
E-mail address:

The GLC has permission to share contact information with classmates
(Check one. GLC does not sell or share our database.) Yes No


Date of Birth (optional) mm/dd/yy:

Race/Ethnicity (this information is requested by some funding agencies):
African American
Asian American
Arab American
Latino
Native American
White
Multi Ethnic
Other

Gender: Female Male Transgender

Neighborhood Association or organizational affiliation (if applicable):



I would like to take part in the following individual workshop(s) at $20/each:


Public Speaking: January 26
Be the Media!: Date TBA
Grant Writing 101: Date TBA
Cross-cultural Organizing: Date TBA
Op Ed Writing: Date TBA


SHORT ANSWER QUESTIONS:


Please tell us a little more about yourself by answering the following questions.
Your answers do not need to be long – no more than a few sentences.

Please describe your current community involvements including: any organizations in which you are involved, positions held, and projects you are working on.



Please share any specific questions or topics that you would like to have addressed in the workshop that you are planning to attend.


ADDITIONAL NEEDS:


The GLC will provide childcare, transportation, and a snack, as well as other accommodations that make participation possible. Please let us know of any special needs you may have.

Childcare needs (children's names and ages):


Transportation needs:

Dietary needs (vegetarian or other):

Other needs:


To electronically submit your completed application click the "submit" button
or print out your completed application and fax it to (608) 441-0085 or mail it to: Grassroots Leadership College,
1321 E. Mifflin St. Suite 201, Madison WI 53703.