2010 Fair Game START Now Summit 10/18-10/19/2010

 

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START Now Summit 2010 Application

Please complete the following application.  Your information will only be used to help tailor our trainings to the needs of the participants. It will also help us to evaluate our success in our goal of advancing women's leadership and will take less than 10 minutes. Thank you in advance for helping us with this goal by taking the time to fill out this application!

Questions about The START Now Summit 2010 location, application, scholarships or stipends, please contact: fairgame@thewhitehouseproject.org 

1. General Information

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Name:

 

 

 

     

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City/State/ZIP:

 

    

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Date of Birth:

 

 

What's this?

 

The White House Project has partnered with Participant Media to develop this unique training opportunity - START Now Summit 2010.  Participant Media's Social Action campaign for Fair Game will explore the issue of nuclear nonproliferation, and emphasize the importance of the participation of women in politics.  If you would like to learn more, we can share your email address with Participant Media - see Participant Media/Take Part terms and conditions.

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Question - Required - Would you like to receive more information about Participant Media's TakePart Social Action campaign for Fair Game?


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Training Questions

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Question - Required - What is your level of voter engagement? (Please check all that apply)

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*8.
Question - Required - What is your level of political activism?

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*10.
Question - Required - What is your level of campaign experience? (Please check all that apply)

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*12.
Question - Required - How likely are you to run for office?





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(Maximum response 255 chars, approx. 5 rows of text)

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(Maximum response 255 chars, approx. 5 rows of text)

 

Demographics

To better serve the needs of all women, please tell us about your background. Again, this information is confidential and only used for training and planning purposes. Questions are in random order.

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Question - Required - How would you describe your political affiliation?










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Question - Required - How do you identify?










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*20.
Question - Required - How would you characterize your income?





*21.
Question - Required - How do you identify?








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*23.
Question - Required - What best describes your level of education?






 

Logistics

*24.
Question - Required - Is English your first language?


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*26.
Question - Required - Can you commit to attending and being on time for all the sessions at START Now Summit 2010?


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(Maximum response 255 chars, approx. 5 rows of text)

*28.
Question - Required - TWHP partners with a range of groups to reach a diverse pool of women. How did you hear about the START Now Summit 2010 training?






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Accommodations and Travel Stipends

The White House Project has partnered with a local hotel to provide accommodations for participants. There will be a limited amount of hotel rooms available and will only be given to those outside the DC metro area.   All participants will be in shared accommodations.

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Question - Not Required - There are limited funds for travel stipends, with priority given to those participants who would not be able to attend otherwise. Note, if you apply for a housing stipend, you will not be able to request a travel stipend.

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