Power + Character Registration ⋆ Citizen University

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Nice to meet you!

These questions will give us some basic info about you, as we prepare to welcome you into Power + Character! Note that we’ll also be asking for an up-to-date photo and biography, so prep those things now. Thank you, and we look forward to meeting you!

First Name*

Last Name*

Nickname or preferred name

If you go by something other than what you listed above, please let us know here.

Phonetic spelling

We want to pronounce your name correctly! Please write it phonetically. For example: hay-SOOS dell-RIO; or KIR-sten SHOE-berg.

Email*

We collect participant data to help us understand who we are reaching, as we strive to bring a wide array of perspectives and experiences into this program. (Info you share here will only be viewed by Citizen University staff and host partners).

When will you be taking part in Power + Character?*

Please indicate which training you’re signing up for.

Oct 26-28, 2026 (Pennsylvania State University)

Dec 1-3, 2026 (Bright Futures)

Jan 11-12, 2027 (Rutgers University)

Jan 27-29, 2027 (University of Washington)

Where do you live?*

City State ZIP

Mobile Phone*

What’s the best mobile number to reach you via phone and/or text?

Community Area*

Please select which population density best represents your community.

Generational Age*

Preferred Pronouns

Ideology*

Left

Center-left

Moderate/centrist

Center-right

Right

Independent

Other

Prefer not to answer

Other*

Racial and/or ethnic identity*

Please select all that apply

American Indian or Alaska Native

Asian (incl. East/South/SE Asia)

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Other

Prefer not to answer

Other*

Gender identity*

Man

Woman

Non-binary

Prefer to self-describe

Prefer not to answer

Self-describe*

School or Organization*

Formally or informally, where do you work or serve?

Title

What's a word or phrase you use to describe yourself or your role in relation to your community?*

Think about who and what you’re representing coming into the Power + Character training. What would you call yourself (beyond any formal title you may hold)?

Approximately how many students or young people do you work with in a given year?*

This will help us get a sense of the reach of this Power + Character training.

Bio*

Introduce yourself in 250 words or less! Feel free to describe your professional experience and also include any other aspects of yourself you want to share.

Photo*

You know that photo of yourself you love to look at, where you look exactly like YOU? Please share that photo with us.

Accepted file types: jpg, jpeg, png, gif, pdf, Max. file size: 10 MB.

Want to connect on social media?

Instagram

@name

https://www.linkedin.com/in/name/

By checking the box below, I give Citizen University permission to photograph, videotape, and/or audio-record me during the program, and to use my image, voice, and/or quotes from my participation to highlight participants work and/or promote Citizen University and its programs.

Yes, I consent

Emergency Contact*

Who should we be in touch with?

First Last

Contact's Phone*

Contact's Email

Contact's relation to you*

Organizing a healthy, joyful, and accessible experience

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. The program takes place in English, and involves lots of discussion, interactive exercises, and use of audio-visual media and printed materials. Participation will also involve logistics of all kinds — from transportation to/from the airport, hotel, meeting space and restaurants; to a full schedule each day; and many things in between. We will do our best to organize the experience responsively with the information you share in mind.

Do you have any access requirements you would like us to be aware of as we plan for our time together?*

Yes

Tell us a bit about your requirements*

Do you have any food allergies we should be aware of?*

We will be providing breakfasts, lunches and snacks over the course of our time together.

Yes

What are your food allergies?*

Be as specific as possible. You may also list preferred alternatives if you’d like. Please note if you carry an epi pen for this allergy.

Do you have any other dietary restrictions or eating preferences?*

We aim to have all restrictions provided for at each meal.

Yes

Tell us about your food restrictions or preferences*

Please check all that apply, including 'Other' if needed.

Lactose intolerant

Vegetarian

Vegan

Pescatarian

Gluten-free

Halal

Kosher

Other: please explain

Additional information: Halal, Kosher, Other*

If Halal or Kosher certified foods are not available, how do you typically supplement/replace these foods? AND/OR Please explain any 'Other' needs.

Any favorite snacks?

Salty or sweet, we want to know!

Do you have any environmental or medical allergies we should be aware of?*

As a group, we may be outdoors — we want to help keep you safe. If your food allergy is also environmental (i.e. cannot be around peanuts), please note here as well.

Yes

Please list your allergies here*

Be as specific as possible. You may also list preferred alternatives if you’d like. Please also note if you carry an epi pen for this allergy.

Getting ready for the program

Please re-read essential information about the Power + Character training (linked below). Then, think about why you are participating in this experience — and how you can create ripple effects by integrating the learning into your work with young people over time.

Power + Character Training

Please indicate your understanding of the training, and commitment to full participation by checking the box below.*

I understand the nature of this training and will be fully present!

What are you hoping to get out of this training?*

How do you picture yourself integrating Power + Character into your work at this point?*

We know this is new, so share thoughts or ideas based on what you know at this point!

Do you have any lingering questions or anything else you would like to share with us?

Almost Done!

Just a few more questions.

How did you hear about Citizen University?*

Tell us where you heard about us!*

Which alum?*

Which organization?*

Do you want to subscribe to the Citizen University Newsletter?*

We send out an email once per month.

Yes please

I already subscribe

No thanks

Power + Character Registration

Nice to meet you!

Want to connect on social media?

Organizing a healthy, joyful, and accessible experience

Getting ready for the program

Almost Done!

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