Liberated Online Cohort Application

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The Building Bridges facilitation model is experiential and intimate. Throughout this series, facilitators will be leading each session with the expectation of active participant involvement. We ask participants to lean in and remain curious throughout the process. This application is for the purpose of ensuring that we have diverse participants within the Liberated Cohort. We are asking that only participants who identity as BIPOC (Black, Indigenous or People of Color) apply as this will be a BIPOC affinity space. Additionally, all sessions will take place online within the Zoom platform so applicants will need online access to participate.

Name:

Email:

Pronouns: (she/hers, they/them, he/his)

OPTIONAL: Employer

Have you completed a Groundwork Session or BIPOC-specific session with Building Bridges? Please state when you participated, or for what session you are registered.

In 1-3 sentences, please tell us why you are interested in joining this 4-part Liberated Cohort Series.

Which Session(s) would you be able to participate in? Please note differing times for each cohort(Check all that apply)

March 5 & 12th 2022 from 10am - 3pm (Saturdays)

May 3, 17, 24, 31 2022 from 4 - 6pm (Tuesdays)

Aug 16, 23, 30 & Sept 6 2022 from 4 - 6pm (Tuesdays)

Oct 4, 11, 18 & 25 2022 from 4 - 6pm (Tuesdays)

Would you be able to commit to all four of the sessions in the cohort series?

Yes

Not Sure

Other:

Clear selection

Have you participated in any kind of training or experience related to diversity, equity and inclusion in the past? And/or a BIPOC affinity/caucus space before? If so, please expand.

How comfortable are you in talking about your racial identity with other BIPOC?

Uncomfortable

Comfortable

Clear selection

How do you racially and/or ethnically identify?

What does it mean to you to be that racial and/or ethnic identity? (please expand on your relationship to/journey with your racial identity)

What is your knowledge, experience and understanding around the topics of racism and colorism?

What is your knowledge, experience and understanding around the topic of white supremacy?

How do you typically show up during conflict with other individuals? How would you handle conflict within a large group dialogue?

Please share one thing you hope to get out of this cohort experience.

Please share one hesitation, concern, or fear you have about this training, if any.

Building Bridges aims to create as diverse of a space as possible within our cohorts and other public trainings. Please share any additional identities that you feel comfortable with us knowing (i.e. age, gender, sexual orientation, religion, ability, class, etc.)

PAYMENT FOR LIBERATED COHORT: Building Bridges aims to ensure that equity is part of the pricing structure of all of our trainings. The cost of this participating in this cohort is $150, however, we work with our participants around what pricing works for them. Please let us know what pricing feels doable for you at this time. Additionally, please note if you believe your employer could cover this cost as part of PD. Check all boxes that apply, and/or fill in your doable price point in "other."

$50

$75

$100

$150

$300 (Including scholarship for one other particpant)

I believe my employer could cover the full amount of this training

Other:

Is there anything else you would like our facilitator team to know about you in regards to your identities, learning style or mental or physical accommodations? Do you have any questions/concerns?

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