Thank you for your interest in serving as a facilitator for YWCA Delaware’s Racial and Social Justice Program. Please take a few moments to complete an application below and tell us about yourself. Email Becca Cotto, Director of Racial and Social Justice and Advocacy at rcotto@ywcade.org.

Name *

First Name

Last Name

Email *

Phone *

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Availability

Weekday mornings

Weekday afternoons

Weekday evenings

Weekend mornings

Weekend afternoons

Weekend evenings

How do you identify racially or ethnically?

YWCA Delaware does not discriminate on the basis of race or ethnicity.

How do you identify your gender?

YWCA Delaware does not discriminate on the basis of gender identity or expression.

Why do you want to become a facilitator for YWCA’s Dialogue to Action (DTA), Conversations about Racism? *

Have you participated in a DTA Conversation about Racism group discussion previously? *

I will attend all sessions of training *

Yes

I will remain attentive and engaged, participating in discussions and activities during training *

Yes

I will be open to learning and trying out skills *

Yes

I will commit to facilitate at least 2 sessions (6 weeks/2hrs each) of DTA, Conversations about Racism over the next 18 months once training is complete. *

Yes

I will make time to prepare and debrief with my co-facilitator during the time of facilitating a group *

Yes

I agree not to promote and utilize this program without giving credit to YWCA DE and Everyday Democracy *

Yes

Thank you!

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