Student Retreat Application

This application is for New School students interested in attending the Organizing Retreat hosted by the Social Justice Leadership Institute (SJLI). The retreat aims to provide students interested in social justice issues with relevant skills and tools for organizing around social justice. The retreat will be held from Friday, September 2nd to Monday, September 5th, 2011. There is no cost to attend. Applications are due by August 1st, but are being accepted on a rolling basis. Send completed applications to For questions or more information please contact Jesse Villalobos -

Contact Information
First Name: E-mail: Division: Status: Special Needs Info: Emergency Contact Name: Phone: Relation: Level: Last Name: Phone: Area of Study/Major: Do You Have Any Special Needs? Preferred Name:

The following questions are designed to help ensure we promote equity and can bring together a diverse group of students in order to make the retreat as relevant and successful as possible for all those attending.

Identity and Background
Gender: Race: Sex: Ethnicity:

Preferred Pronoun: Additional Identity Information: Bilingual? Country of birth: Did you study your family history growing up?


Do you identify as differently-abled? Spoken languages: Where were your ancestors from?


Your socioeconomic-economic background growing up: Are you the first in your family to attend college? In your own words, briefly explain what “social justice” means to you.

Have you ever attended a Social Justice oriented retreat before? Have you been part of an organization that did Social Justice work? Have you attended an anti-oppression or anti-discrimination training? Are you interested in contributing to or co-leading a workshop? If yes, please list the topics or issues: Are you involved in any social justice campaigns or organizing currently? If yes, please list the campaigns or issue areas:

Are you currently involved with any groups on campus? If yes, please list the groups: If you anticipate any barriers that might hamper your ability to fully participate in the retreat (i.e. family or work commitments, health issues, etc.), please check here and we will follow-up with you in hopes of accommodating your needs. Please explain why you would like to attend this Social Justice leadership retreat, what you hope to learn at the retreat, and what you can offer as a participant.


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