RWJF Global Learning Cohort — Info Form for US trip 2025 ⋆ Citizen University

Name(Required)

First Last

Organization(Required)

Title/Role(Required)

Website

Where can people learn more about your work?

Email(Required)

How can we stay in touch with you during the planning process?

Phone(Required)

If we need to reach you by phone, our default will be to use Whats App. Please let us know if this doesn't work for you.

Pronouns(Required)

We'll add your pronouns your name tag so people know how to refer to you. For example: she/her; they/them; etc. (or prefer not to say).

City + Country(Required)

Short Bio(Required)

Introduce yourself in around 250 words. Feel free to describe your professional experience and to also include any other aspects of yourself you want to share. We will share these bios with the Global Learning Cohort members in advance of our meeting.

Headshot(Required)

Please upload a photo that helps us get to know you better. It can be an informal snapshot, but please make sure your face is clear!

Max. file size: 31 MB.

Emergency contact name(Required)

Emergency contact relation to you(Required)

Emergency contact phone number(Required)

Getting here

We'll plan to book your hotel stay, flights, and ground transportation as needed. Please provide some information to help us in that process.

Full Legal Name on Passport

If the name you go by is different from your legal name, please provide you legal name here

Birthday(Required)

Gender on Passport(Required)

Please provide your legal sex/gender as written on your passport

Passport Number(Required)

Dates of Travel

As a default, we'll plan to book travel so that you arrive in Seattle on the morning of April 29 and depart in the afternoon/evening of May 4.

These travel dates work for me

I would like to request different travel dates

Travel Requests

Please tell us more about your requested travel dates.

Any other travel-related notes or requests to share?

Dietary and accessibility needs

We strive to host inclusive, accessible experiences that enable all participants to engage fully, including individuals with disabilities, faith or cultural considerations, or any specific access needs. Participation will involve logistics of all kinds — from transportation to/from the airport, hotel, and meeting space; to a full schedule each day; to use of slides and audio-visual media, printed materials; and many things in between. We will do our best to organize the experience responsively with this information in mind.

Do you have any dietary restrictions?(Required)

None

Lactose intolerant

Vegetarian

Vegan

Pescatarian

Gluten free

Halal

Kosher

Other: Please explain

Other

If Halal or Kosher certified foods are not available, how do you typically supplement/replace these foods?

Do you need anything to be comfortable accessing and enjoying this event?

For example, sensory needs, mobility needs, etc. Please let us know here if you will need translation services.

Content Planning

Help us refine our three core learning questions(Required)

What curiosities or challenges would you like to discuss and problem solve with this group?

Help us curate guests to join us(Required)

What topics or issues feel especially pressing for your work now? What types of civic innovators would you like to meet during your trip to the states?

Anything else to share?

Comments

This field is for validation purposes and should be left unchanged.

Global Learning Cohort — Seattle Trip Confirmation

Getting here

Dietary and accessibility needs

Content Planning

Social Navigation

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