National Civic Collaboratory New Member Form

We’re excited you’re joining the National Civic Collaboratory community!

We want to be very transparent about how we are using the information you provide us. Citizen University will never share, trade, or sell this information to anyone. This form will be used for internal purposes. We collect demographic data to help us understand who we are reaching in an effort to be equitable and accessible for all. We strive to bring a wide array of perspectives and experiences into our programs. Please feel welcome to write in “prefer not to say” for any question below.

If you make a career change or the answers to any of the questions change, please let us know by emailing Vicki Rubio, Program Manager, at [email protected]. Vicki can also help you if you have any questions or concerns about membership expectations and maintaining active membership.

Name(Required)
We want to pronounce your name correctly, so please write out your name phonetically. For example: hay-SOOS dell-RIO; or KIR-sten SHOE-berg.
We'll use this email to send you invites and information about the Civic Collaboratory. It will also be included in the membership directory.
Email Type(Required)

About you

Please share your racial identity. For example: mixed race; White; Asian; etc. (or prefer not to say).
Please share your gender identity. For example: female; nonbinary; etc. (or prefer not to say).
Please share the pronouns you use. For example: she/her; they/them; etc. (or prefer not to say). And if your pronouns change, you can update them with us at any time.
Please share the political ideology you identify with. For example: conservative, liberal, libertarian, progressive, (or prefer not to say).
Generation(Required)
Location(Required)
Which best represents your community?
Please share any accessibility needs you have, so we can best accommodate you in our spaces. For example: wheelchair access; ASL interpreter; nursing childcare area; etc.

About your work

Organization Type(Required)
Organization Sector

Final details

Max. file size: 31 MB.
Media Release(Required)
I permit that Citizen University may take photographs and videos of me, and/or record quotes by me, for promotional purposes. I allow my name to accompany these assets. All assets will be used with the intent of amplifying participants’ work or promoting Citizen University programs.
National Civic Collaboratory Member Commitment(Required)
As a member of the National Collaboratory, I commit to attending at least one convening per year; sharing my experiences and perspective and listening to those of others in the spirit of building bonds of trust and affection; and utilizing my knowledge and network to benefit the collective power of the Collaboratory.
This field is for validation purposes and should be left unchanged.