• For roster and name badge (if different):
  • Board/Commission/Council/Association/Committee/Task-force/Membership, etc.:

  • Periodic reporting on demographics, along with other information, is provided to our funders to evaluate the impact of our programs in the communities we serve. Please kindly provide the following information:
    *Please check one
  • Attendance: Monthly program sessions are held via Zoom unless otherwise specified. In addition, participants are expected to work on a task force to plan and implement a project designed to build a stronger, more unified community. We estimate task force activities may require approximately six additional hours each month beyond the scheduled monthly sessions. Participants are expected to attend a minimum of 85% of the program sessions and 85% of the task force meetings. I have read and understand the responsibilities as described above:
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