TALKING CIRCLES
APPLICATION FOR STUDENT PARTICIPATION
The Talking Circles on Race and Racism are candid, facilitated dialogues that give people the
opportunity for self-reflection and sharing of experiences through sustained dialogue. The
Diversity Awareness Committee, Ithaca College Office of Human Resources, Center for Faculty
Excellence and the Multicultural Resource Center hope to bring approximately 14-16 racially
and ethnically diverse participants together beginning Tuesday, September 23rd, 2014, 6:00
PM to 8:00 PM to discuss their personal experiences with racial identity, race issues, and
racism. In order to develop trust and confidentiality, we ask that participants commit to the
once per week sessions over five consecutive weeks (September 23, 2014 through
October 21, 2014), dinner will be provided at all five sessions.
PLEASE COMPLETE THE FOLLOWING FORM & RETURN BY
September 12th, 2014 VIA EMAIL TO Michelle Rios-Dominguez –
mriosdominguez@ithaca.edu
Name: ________________________________________ Email: ____________________________________
School year: ________________ Major/Minor: _____________________________________________
M/F: _______ Race/ Ethnicity: _________________________ Hometown: ____________________
Are you willing to provide feedback via survey regarding your experience: Y / N
Please list any leadership roles and other involvement in organizations on campus:
Please explain your interest in participating in the Talking Circles:
Due to the complex nature of these conversations, I agree to keep confidential and will
not disclose any other participants’ identities, opinions, or experiences.
X_____________________________________________________________ Date: ____________________
For more information contact: Kerry Spitze at kspitze@ithaca.edu