Fillable Form 30: Annual Students of Color Conference Calling (Cascadia Community College)

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Form 30: Annual Students of Color Conference Calling (Cascadia Community College)

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30
th
Annual Students of Color Conference
“Calling All Changemakers: 30 Years of
Unapologetic Activism”
April 23
rd
- April 25
th
, 2020
Thursday - Saturday
Yakima, Convention Center
Conference Application
Submit completed applications to The Center for Culture, Inclusion and
Community, The Center CC1-002 by February 6
th
, 2020.
Incomplete applications will not be considered.
The Students of Color Conference brings together more than 800 college students from
across WA State to discuss topics that include ethnic and racial identity development,
academic success, skills for promoting social justice, and intercultural communications.
Cascadia College is an equal opportunity institution and does not discriminate on the basis of race, color, religion,
gender and/or sex, disability, national origin, citizenship status, age, sexual orientation, veteran's status, or genetic
information. All Cascadia materials are available in alternative formats and can be requested by contacting the
Human Resources office. To request disability accommodations for student events, please contact Disability
Support Services at 425.352.8128 or disabilities@cascadia.edu at least ten days prior to the event.
Conference Eligibility:
The following students are eligible to attend the conference:
Any students enrolled in any program at least for 5 credits at Cascadia College
Students must have a minimum 2.5 Cumulative GPA / good standing.
Students must be enrolled at Cascadia for Winter & Spring 2020.
Student must be free of conduct sanctions.
There are limited spaces available – priority will be given to the first-time SOCC
applicants.
Contact Information
Name
SID Number
Email
Cell Phone
T-Shirt Size ( S – M – L – XL – 2L – 3L – 4L – 5L)
Vegetarian
Gluten-Free
Nut-Free
Halal
Vegan
Non-Dairy
Kosher
Other – specify below
Sign Language Interpreter
Image Captioning
Note Taker
Braille
Supporting Listening Device
Mobility Assistance Device Access
Open Captioning
An Assistant Will Be Accompanying Me
Other – specify below
How do you ethnically / racially identify?
Self-Describe
What is gender identity?
Self-Describe
What is your sexual orientation?
Self-Describe
African
Middle Eastern / South Asian
African American / Black
Native American / Indian First Nations
Asian American
and Indigenous People
Biracial / Multiracial
Pacific Islander
International
White
LatinX
Women’s Identity
Muslim Identity
QTPOC Identity
Students with Disabilities
Dreamers / Undocumented Students
Men’s Identity
Student Name
Emergency Contact
Emergency Contact Phone
Relationship
Short Answer Questions
This conference is open to all students from various backgrounds and experiences. When you
let us know more about you, it will better prepare our efforts in providing you support and
learning while at the conference. Please answer thoroughly and thoughtfully.
These are Your Responsibilities and Commitments for participation in the Students of
Color Conference:
I agree to attend the required SOCC orientation meeting prior to the conference, date and
time TBA.
I will be enrolled in classes at Cascadia College in the Spring Quarter of 2020.
If selected, I will follow the rules and regulations of the conference and will accept the
consequences if I do not adhere to them. I will also agree to sign the SOCC Policies and
Procedures Form.
If for some unavoidable reason I find it impossible to attend this conference, I will inform
Larissa Tikhonova no later than 48 hours in advance by calling 425-352-8143 or e-mail
Itikhonova@cascadia.edu.
I understand that I am representing Cascadia College and will follow the student conduct
code.
I will make arrangements with my instructors for time/assignments missed. I also agree to
share some of my experiences and perspectives regarding the conference afterwards.
I understand that transportation and hotel accommodations will be provided and paid by
Cascadia College.
I understand that unofficial transcripts and quarterly class schedule will be printed and used
to determine eligibility to attend the conference.
Student Name
Student Signature
Date
All students who are attending the Students of Color
Conference must read and sign this form.
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Form 30: Annual Students of Color Conference Calling (Cascadia Community College)

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Completed 8 October 2020

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