Voices of Change Application

First Name *

Last Name *

Street Address *

Apt/Unit/Suite #

City *

State *

Zip Code *

Phone (Including Area Code) *

Email *

Application

How did you learn about the Voices of Change program? *

People have many different reasons for wanting to join the Voices of Change program. What are your hopes for yourself in joining the Voices of Change program? *

Do you have any ideas at this time about what some of the main points are that you hope to convey to others from your experience? (This is something that will be discussed further during your interview.) *

Have you ever shared your experience publicly before? If you have, what did you like about that experience? What was challenging about it? *

What concerns do you have about sharing your story publicly and how it may affect you? *

We do everything we can to keep your information private; however, we cannot guarantee complete confidentiality for participants. There may be times when we may need to share certain identifying information such as your name, type of abuse, and your contact information with other CRCC staff, volunteers and event organizers. Do you have any concerns about that? *

Are you currently or have you in the past two years been involved with CRCC in another capacity? (Please check all that apply.)

Do you have any accommodation needs to be able to fully participate in the training? (i.e. interpreters, large print materials, wheelchair-accessible space, etc.?)

Thank you!

Please click "submit" below to submit your application. Once your application is received, you will be contacted to set up a time to come in for a brief interview with the workshop facilitators. In order to participate in the workshop, you will need to complete an in-person interview. If you have questions, please email Kim at kimh@clevelandrcc.org.

Voices of Change Application

Apply for Voices of Change

Application

Thank you!