New York City Leadership Jam 2017 Application

Complete Name (required)

Nickname (what you prefer to be called, if different):

Your Email (required)

Organization or Organizational Affiliation (if applicable):

Website of Group (if applicable):

Street Address (required)

City (required)

State / Province (required)

Zip / Postal Code (required)

Country (required)

Home Phone (if applicable):

Cell Phone (if applicable):

Work Phone (if applicable):

Birthday (Month/Day/Year) (required)

How did you hear about the Jam? Please list sources by name -- we want to give them a shout out if possible!:

Who You Are

The people in the room are the focus of the Jam, and sharing our stories, experiences, ideas, etc., through different formats, is how we engage and learn together. The following series of questions is meant to be a taste of this principle.
Don’t worry about spelling or grammar or eloquent articulation. We just want to get a sense of who you feel you are.

1. How would you describe yourself? (gender identity, ethnic background, sexual orientation, class, anything else that makes you who you are.) We ask because we value diversity, the opportunity to create safe space, and want to know how to best meet participant needs:

2. What’s your current focus in the world? What does your work (or play) look like? Please be as specific as possible about what you do, why you do it, and the values behind it:

3. What is your relationship to community in NYC? What would it take to be part of a thriving community?:

4. What’s present for you right now? What questions are you grappling with? :

5. Why do you want to attend the Jam? What do you hope to receive? What do you hope to share?:

6.Please share with us any concerns, doubts, fears or reservations you would have about attending the Jam. What would help make the Jam safe, welcoming, and accessible for you?:

Anything else you'd like to tell us?:

Please give us a mini-bio (a paragraph version of your story) written in the third person (for example, using "she" instead of "I"). Talk yourself up! Include conributions you've made, any awards or accomplishments, organizations you've been involved with, etc. This is the bio that will be shared with other participants of this Jam, and will be used for the YES! website. (You can always modify it later.) :

Costs of Attending

The New York City Leadership Jam costs approximately $650 per person, of which $320 covers food, lodging, materials, and local transport; and $330 covers organizing and facilitation stipends and childcare. Are you or your organization in a position to pay the $650 tuition? If not, how much are you able to contribute (and what amount of scholarship would you require)? We request you consider a baseline of $320:

We invite work trades as well. Are there other non-monetary ways that you might be in reciprocity with the Jam (carpooling, photography/film, any other particular skills, other in-kind contributions, etc.)?:

We never want money to be a barrier in participating in a Jam, so we will do everything we can to make it work for you to attend.

A number of partial scholarships are available upon request. We can also work out with you a monthly payment plan (for example, $65/month for 10 months).

Additional donations above the event price are welcome and help us provide scholarships to enable the diversity upon which this event thrives (they are also tax-deductible).

Travel expenses are the responsibility of the participant, though we will help with providing train schedules and arranging rides. If you are selected for the Jam, we will be following up with you to ask you about diet, housing, travel plans, etc. We’ll do our best to meet your needs, in getting to and enjoying the Jam.

Thanks so much for taking the time to fill out this application! We’ll be in touch as soon as we can. In turn, if you have any questions or concerns, please do not hesitate to get in touch.

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