ACT for Women and Girls PowerBase

User login

Username *

Password *

Request new password

Advanced Academy Application

ACT for Women and Girls Advanced Academy is a new 9 month program. Anyone who has completed at least 1 year long program can participate. Participants are expected to attend at least 85% of all meetings, complete assignments and keep track of their goal(s).

1 Start 2 Complete

Contact 1

First Name

Last Name

Birth Date

Month

Day

Year

Street Address

City

Postal Code

State/Province

Phone Number

Screen Name

Screen Name 2

Screen Name 3

Demographics

Gender Pronouns

They/Them

She/Her

He/His

Ethnicity / Race

Select all that apply

Asian or Pacific Islander

Black or African-American

Hispanic or Latino

Middle Eastern

Native American or American Indian

White

Other

Decline to state

Multiethnic/Multiracial

Interests

Issues Interest

What issues has this person expressed interest in?

Immigrant Rights

Economic Justice

Workers' Rights

Environmental Justice

Women's Rights

Reproductive Justice

LGBTQ Rights

Young Families' Rights

Racial Justice

Housing Justice

Questions

What are your Reproductive Justice dreams for the Central Valley?

What would you like to get out of this new program?

What would you like to bring to this program?

This program will take an estimated time commitment of 20 hours a month with bi-weekly meetings on Thursdays from 6-8pm. Are you willing to make this time commitment?

Yes!

No, not at this time. How else can I support?

Yes, with support/adjustment. Lets chat more.

This program will have events, assignments, networking goals and group goals. Can you commit tackling goals outside of bi-weekly meetings?

Yes! I know how to self manage my time and goals.

I'm not sure. Can you tell me more?

Yes, with support, tools and help I can manage.

Any access opportunities that will help you participate in this community?

Mental, physical or emotional?

Submitted by Marquez on Wed, 08/21/2019 - 19:55

ACT for Women and Girls PowerBase

User login

You are here

Advanced Academy Application