Turn in completed applications and signed forms to Student by R3YiEM


									  Power of One Conference
                               Application Packet
                              April 1-3, 2011
                              Vancouver, WA

             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.

                             Application Process
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
    Spring 2011)

                        Conference Description
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.

                                     Questions? Contact:
                      Cal Erwin-Svoboda, Student Activities Coordinator
                           csvoboda@ghc.edu or call 360.538.4078
                                Lana Lile, Program Specialist
                               llile@ghc.edu or 360-538-2527
                 Application for Power of One Conference
Name:                                                            Student ID#:

Email:                                                           Phone:

Emergency Contact:                                                 Number: _______________________

Gender:                                                 Date of Birth: ___/___/___

Allergies: _____________________________________________________________________________

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 csvoboda@ghc.edu

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?

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.

___________________________________________                  _________________________
 Signature                                                         Date

To top