North America Leadership Jam 2021 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 organizing 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 selected for the Jam, 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):

What pronouns do you use (he, she, they, ze, or any others)?:

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

How do you identify? (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's your focus in the world currently? What are you passionate about and 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 are your questions right now? What's alive for you? What are your current places of challenge, growth, and excitement?:

Why do you want to attend the Jam (as opposed to a conference, workshop, meditation retreat, etc.)? How do you feel it will be valuable for you at this point in your life/work journey?:

An important part of the Jam is bridge-building. Why is this relevant to you? Can you share a time when you have been successful, and when you have been challenged, as a bridge-builder?:

Please share with us any concerns, doubts, fears or reservations you would have about attending the Jam:

Please give us a mini-bio (a paragraph version of your story) written in the third person (for example, using "she" instead of "I"). Please use the gender pronoun that works for you. 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, and will be used for the YES! website. (You can always modify it later.) :

Anything else you'd like to tell us?:

Costs of Attending

The Zoomy North America Jam costs approximately $400 per person, and we invite tuition on a sliding scale of $100-$400. How much can you contribute to the 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.

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

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