Pacific Northwest Jam Application 2021

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. Don’t worry too much about grammar, spelling, or making full sentences. 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 accepted immediately, you may be placed on a waitlist 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.

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)

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 a variety of 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.

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 a safe space and to best meet participants’ needs:

What are your questions right now? What's alive for you? What are your current places of challenge, growth, and excitement? In your community? Your work life? Personally? In the PNW? Please be as specific as possible about whatever you do, why you do it, and the values behind it.

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

Why would you like to attend the PNW Jam? What do you hope to give? What do you hope to receive? How do you feel the Jam will be valuable for you at this point in your life/work journey?

There will be a rich variety of beliefs and experiences among those who come to the Jam, and a significant part of our time together will involve listening to and learning from each other. How do you connect with people who are different from you? Where do you struggle with connections?

What supports you in making meaningful connections? What would you need in order to make the Jam feel safe, welcoming, and accessible for you?

Please share with us any concerns, doubts, fears or reservations you would have 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 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:

Anything else you'd like to tell us?:

Costs of Attending

The tuition for the Zoomy Jam is offered on a sliding scale of $50- $300 to support honorarium for organizers and facilitators. 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. If cost is a barrier to you, contact us and we will work together with you to find a way. Some partial scholarships are available. We can also create a flexible monthly payment plan that can be as low as $10 a month. If you have more resources, additional donations above the event price help us provide scholarships to support the broad spectrum of participation. It’s the diversity of the Jams that make them thrive. Donations above the tuition are also tax-deductible.

How much can you and/or your organization contribute to tuition for 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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