Racial Healing Circle Registration Form

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Hello! Thanks for your interest in participating in a Racial Healing Circle. Please fill out this form so we can get you connected.

Your Name *

What's your connection to Mason? *

Undergrad Student

Graduate Student

Staff

Faculty

Alumni

Required

What is your Mason affiliation? (Your major, department, title, etc.) *

E-Mail Address *

This is an optional question, but it helps us put participants into diverse pairings for the circle. How do you describe your ethnic roots? You're welcome to check at least one and be more specific in the "Other" box.

Asian

Black or African American

Desi or South Asian

European or White

Hispanic or Latinx

Southwest Asian-North African (SWANA) (formerly known as Middle Eastern-North African (MENA))

Native American or Indigenous

Native Hawaiian or other Pacific Islander

Other:

Please select which Racial Healing Circle you want to join. Space is limited to the first 16 people who sign up per circle. You may choose more than one, but please only sign up for time slots you can commit to. *

Wed, Nov. 17, 9am-12pm (Virtual)

January 2022 during the MLK Event (Date and Time TBD, virtual/in-person TBD, check if interested in more info)

Required

Have you attended a Racial Healing Circle before? *

Yes, at Mason

Yes, but not at Mason

This will be my first one ever!

What do you hope to learn and gain from your participation in a RHC? *

Is there anything else you would like us to know about you?

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