TALKING CIRCLES
APPLICATION FOR STUDENT PARTICIPATION
The Talking Circles on Race and Racism are frank, facilitated dialogues that give people the
opportunity for self-reflection and sharing of experiences through sustained dialogue. The
Diversity Awareness Committee and Multicultural Resource Center hope to bring
approximately 20 racially and ethnically diverse students together beginning
TUESDAY, FEBRUARY 5, 2013, 5:30PM-7:30PM
to discuss their personal experiences with racial identity, race issues, and racism. In order to
develop trust and confidentiality, we ask that students commit to the once/week sessions over
five consecutive weeks (Feb. 5, 2013-March 5, 2013)
FOR CONSIDERATION, PLEASE COMPLETE THIS FORM & EMAIL
IT TO PAULA IOANIDE – pioanide@ithaca.edu BY JANUARY 28, 2013
Name: ________________________________________ Email: ____________________________________
School year: ________________ Major/Minor: _____________________________________________
M/F: _______ Race/ Ethnicity: _________________________ Hometown: ____________________
Are you willing to provide feedback via survey regarding your experience:
Yes
No
Please list any leadership roles and other involvement in organizations on campus:
Please explain your interest in participating in the Talking Circles on Race and Racism:
Due to the complex nature of these conversations, I agree to keep confidential and will not
disclose any other participants’ identities, opinions, or experiences. Typing your name will be
considered in lieu of your signature.
X_____________________________________________________________ Date: ____________________
For more information contact: Paula Ioanide at pioanide@ithaca.edu