Final Application Deadline: June 30, 2017

If you have previously participated in the Southern Leadership Jam, and want to come to this one, then please write to us at <southernjaminfo@gmail.com> for a separate alumni application. Thanks!

Note: We encourage you to cut-and-paste your answers to this application into a word doc, BEFORE you hit the submit button, as we are occasionally experiencing some technical difficulties with this contact form.  Once you have received confirmation from us that we received your application, then you can go ahead and delete the word doc. Thank you!

Important Note: 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.

And, just to be clear, we don't have a formal selection process. This is not a competition or a race where we select the best applications or judge whose work is better and whose isn't. However, we are limited to a maximum of 30 participants and we wish to ensure a circle of diversity with a right mix of qualities so that the potential of the space is enriched and it becomes meaningful for all. The selection would only reflect this attempt.

* Please note that if you are selected and choose to attend, your name and bio will be shared with the other participants of your Jam 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. More info on this is below.

Complete Name (required)

Preferred Name or Nickname (what you prefer to be called, if different from your Complete Name):

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:

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.

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:

What would you need in order to make the Jam safe, welcoming, and accessible?

What language(s) do you feel most comfortable speaking?

What is your current focus in the world? What are you actively working on? Please be as specific as possible about whatever you do, why you do it, and the values behind it.

What is your vision for your community, for the South and Appalachia? What challenges and opportunities do you see in reaching it?

Where are you in your personal journey? What questions are present for you? What directions are you currently growing or seeking to grow? What are your passions?

Why would you like to attend the Southern Jam? What do you hope to give? What do you hope to receive?

Do you have any doubts, fears or concerns about attending the Jam? And/or 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 "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, just prior to the Jam, and you can always modify it later:

Costs of Attending

Tuition for the Jam is $900, of which $450 covers food and lodging for the time, while $450 covers program expenses (organizing and facilitation honorarium, childcare, materials, supplies). A number of partial scholarships are available upon request, on an as-needed basis. We also have monthly payment plan options. Additional donations above the event price are welcome and help us to provide scholarships to enable the diversity upon which this event thrives (they are also tax-deductible). 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.

Are you or your organization in a position to pay the request of at least $600 for tuition? If not, how much are you able to contribute (and what amount of scholarship would you require)?:

We invite work trades as well. Are there other non-monetary ways that you might be in reciprocity with the Jam? (any particular skills, other in-kind contributions, etc.) For example, future fundraising for the Jam, graphic design, website and social media skills, airport shuttling (requires a car), and/or donations of food, workshop materials and art supplies.:

Travel expenses are the responsibility of the participant (the closest airport is Baton Rouge, LA), though we do help to arrange carpools from the airport and other cities in the South, as much as possible. If you are selected, we will be following up with you to ask you about diet, housing, travel plans, childcare, etc. We want to be sure to meet your needs at the Jam.

Thanks so much for taking the time to fill out this application! We'll be in touch as soon as we can.

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Note: We encourage you to cut-and-paste your answers to this application into a word doc, BEFORE you hit the submit button, as we are occasionally experiencing some technical difficulties with this contact form.  Once you have received confirmation from us that we received your application, then you can go ahead and delete the word doc. Thank you!