Spring 2018 Spartans-In-Dialogue Student Interest Form
Spartans-In-Dialogue is a 5-week interactive dialogue experience designed to build relationships across difference and explore topics related to racial identity, race relations, and intersectionality. As a participant, you will learn more about yourself and understand others who are different than you while practicing dialogue skills to communicate effectively about difficult topics. You will learn communication, group dynamics, and diversity skills you can document on the co-curricular transcript to help you with employment, graduate, and professional schools.

Dialogues begin the week of October 14 through the week ending November 16, 2018. All participants who complete this program will receive an Official Certificate of Completion.

If you are interested in participating in the Spartans-In-Dialogue program, please complete the form by 9am on Monday February 19,  2018. You will be notified by Monday, February 26th regarding your group placement.

If you have any questions about the Spartans-In-Dialogue program, contact carla.fullwood@uncg.edu, 336-334-5090.

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First Name *
as you would like it to appear on the Official Certificate of Completion
Last Name *
as you would like it to appear on the Official Certificate of Completion
Preferred Name *
as you would like to be addressed in dialogue settings
Pronouns *
UNCG ID# *
UNCG Email *
UNCG Contact Number *
Format 123-456-7890
What is the best way to reach you? *
Required
T-shirt Size *
Required
What times are you available to participate in a Spartans-In-Dialogue group? Groups will meet 2 hours/week over 5-weeks between the weeks of October 14 - November 11 2018. *
Please indicate your top two (2) choices. You will be notified no later than Thursday, Octoer 4 regarding your group placement.
Yes, this is my preferred option
Yes, only if i can't get my preferred option
No, I can't meet at this time
Tuesdays from 1pm-3pm (3/13, 3/20, 3/27, 4/3, 4/10)
Thursdays from 2-4pm (3/15, 3/22, 3/29, 4/5, 4/12)
Thursdays from 6-8pm (3/15, 3/22, 3/29, 4/5, 4/12)
Spartans-in-Dialogue Kickoff- Friday, February 2, 2018, 4:30pm-7pm, EUC Claxton *
A Spartans-In-Dialogue Kickoff event for participants to begin engaging in the dialogue process. You will engage in interactive activities to better understand the goals of the Spartans-In-Dialogue programs and meet other participants who signed-up.  If you cannot attend the Kick-off that is OK, you can still sign up for the program and be assigned to a group.
Briefly describe what you hope to learn or gain by participating in the Spartans-In-Dialogue program. *
100 words or less
Briefly describe the experiences or interests you have related to race/race relations that you can contribute to a dialogue. *
100 words or less
Participant Information
To assign groups, your availability time will be the first consideration. The following information is collected to assist in putting together a balanced and diverse group of participants for the dialogue experience after considering your time preference. This information will not be used to to decide whether or not you participant in the program as all students who sign-up will be placed in a dialogue group. All information will be kept confidential*, and ALL ANSWERS ARE VOLUNTARY.

*The planning team coordinating the group assignments and facilitators for respective groups will be the only individuals with access to your responses. Please contact carla.fullwood@uncg.edu or 336-334-5090 or additional questions.

Year in School
Clear selection
Age
Major or Program
I identify as:
(Select all that apply)
I identify as:
(Select all that apply)
Please provide any comments that would better help us understand your responses to the above questions, or anything else you would like us to know. *
Thank you for your interest in the Spartans-In-Dialogue  program!
Please contact Carla Fullwood (carla.fullwood@uncg.edu, 336-334-5090) with questions about this program, this interest form, or the assignment process.
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