Power of One Conference
April 1-3, 2011
If you are selected, you must attend one of the
Pre-departure Orientations scheduled below:
Tuesday, March 15 from 1:00-2:00 pm in Choker Dining Room
Thursday, March 17 from 2:00 – 3:00 in Choker Dining Room
Applications must be turned in to Student
Activities by Thurs., February 10, 2011 by 4 pm
Student Activities Mission:
Student Activities promotes activities, which embrace the diversity of each student’s unique interests
by providing out of classroom experiences that enrich and enhance their academic experience.
Please complete this application if you are interested in attending the 2011 Power of One Conference:
Turn in completed applications and signed forms to Student Activities by Thursday, February
10, 2011, by 4 pm.
Please attach a copy of your unofficial transcript for proof of registration and GPA.
If selected, you must attend one of the pre-departure orientations:
o Tuesday, March 15 from 1:00-2:00 pm in Choker Dining Room
o Thursday, March 23 from 2:00-3:00 pm in Choker Dining Room
Requirements for Attending the Leadership Institute Retreat:
Must be able to attend all three days
Must ride the bus, which will leave and return to GHC, with the group
Must abide by the rules of NWSLC as well as the college
Must be 17 as of March 1, 2011
Must have a GPA of 2.0 or higher
Must be a current registered student at Grays Harbor College. (Registered for Winter 2011 and/or
The Power of One is a Northwest student leadership conference designed to encourage and empower
lesbian, gay, bisexual, transgender, queer, and questioning college students, their allies, and the faculty
and staff who support them. The conference content seeks to enrich students’ lives and promote
healthy and safe communities on our campuses and in our societies.
Cal Erwin-Svoboda, Student Activities Coordinator
email@example.com or call 360.538.4078
Lana Lile, Program Specialist
firstname.lastname@example.org or 360-538-2527
Application for Power of One Conference
Name: Student ID#:
Emergency Contact: Number: _______________________
Gender: Date of Birth: ___/___/___
Please indicate meal preference below:
[ ] Vegan [ ] Vegetarian [ ] Kosher [ ] No Dairy [ ] Other (please describe below):
If you require accommodations for a disability to participate please contact: Cal Erwin-Svoboda in Student
Activities at 360-538-4078 or email@example.com
Leadership position(s) for the 10-11 school year, if any. _________________________________________
How long have you attended Grays Harbor College?
Did you attend the Power of One Conference last year? _________
Are you registered at Grays Harbor College for [ ] WInter 2011 [ ] Spring 2011
T-Shirt Size (Please Circle One): XS S M L XL XXL Other: _____
1. What do you hope to gain from this experience?
2. Why are you interested in attending the Power of One Conference?
3. How do you see diversity in action at Grays Harbor College?
4. PERSONAL STATEMENT
In the space provided below, please discuss:
a) How do you plan to take what you learn from the Power of One Conference and contribute to
diversity at Grays Harbor College?
5. List any Volunteer experience or participation in school- related activities (Music, Art, Clubs,
School paper, etc.) you have or any projects you have contributed to (e.g. government agencies,
community groups, religious organizations or political campaigns). Please attach extra pages if
Name of Organization Your Role Dates
I understand that if I do get accepted to attend the Power of One Conference and I need to
cancel, I must notify Student Activities in writing by Thurs. March. 15. A cancellation fee of $50
is required after that date.