Wellness and Healing Justice Jam application

Due to the small and personal nature of the event, this questionnaire is longer and more in-depth than most, because we want to get to know you better. Please share as much as you feel comfortable sharing. There is no min/max length for responses and no pressure. We only ask you to share what you feel is 'enough'. We will follow up with more questions or a phone call if we need more information.

Also, please note that all of your answers, including your name and basic info, will be kept in full confidentiality.* Only the leadership team will have access to your application. The more the team learns about you, the more informed their decision about selection can be.

Participant selection will be based on multiple factors, including prioritizing the inclusion and representation of a diverse participant body. Space is limited. If you do not get selected immediately, you may be placed on a wait list if space becomes available.

* Please note that if you are accepted, your name and bio will be shared with the other participants of your Jam just prior to the event. Following the Jam, we will put this information up on our website so that you can participate in the alumni community, unless you request otherwise.

Complete Name (required)

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

Gender Pronouns::

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)

Phone (if applicable):

Birthday (Month/Day/Year) (required)

How did you hear about the Jam? Please list sources by name:

How do you identify? (Gender, ethnic background, sexual orientation, class, ability, and anything else that makes you who you are.) We ask because we value diversity and want to know how to best meet participant needs:

We value creating accessible environments for participants. What access needs would be important for us to accommodate for your participation?

Who You Are

The participants 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 are.

What is your personal story around your role as a healer/practitioner/advocate? What does your current work (or play) look like in the world? What are your skills, interests and passions? We invite you to share your own story in ways that feel authentic to you:

What is your vision for wellness and healing justice? What are your burning questions and growing edges related to wellness and healing justice?:

Why do you want to participate in the Zoomy Wellness and Healing Justice Jam (as opposed to a conference, a workshop, a meditation retreat, etc.)? What are you hoping to receive? What do you want to give?

Do you have any doubts, fears or concerns about attending the Jam? Is there 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 “they,” “she”, or “ze” instead of “I”). Talk yourself up! Include contributions 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. (You can always modify it later.):

Costs of Attending

Tuition for the Wellness and Healing Justice Jam is offered at a sliding scale of $50-$300 per participant to support the costs of organizing and facilitation. Any additional payment that people are able to make would go directly to financial support for others to attend this jam. 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.
 Partial scholarships are available. Additional donations above the event price are welcome and help us provide scholarships to support the broad spectrum of participation on which this event thrives (they are also tax-deductible). We can also work with you to create a monthly payment plan (say $20/month for 5 months, for example). How much are you or your organization/school/institution able to contribute to this experience?

Thanks for applying to the Wellness and Healing Justice Jam!
We’ll be in touch as soon as we can.

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