2015-2016 APILR Participant Application
2015-2016 APILR PARTICIPANT APPLICATION
January 22-24, 2016

APILR Background
The 22nd annual Asian Pacific Islander Leadership Retreat (APILR) empowers students with the necessary leadership skills and resources to make a difference on campus and in their communities through an examination of self-identity, current API community issues, and an application of skills to the communities. This will be accomplished through workshops and activities focused on self-awareness and self-application.

Application Deadline
Applications are available as a Google form or word document, and both can be found on the Cross Cultural Center website: http://ccc.ucdavis.edu/apilr.html. Paper applications can be emailed to davisAPILR@gmail.com or printed out and dropped off at the Cross Cultural Center (CCC). Please submit your application by Monday, November 2, 2015 to be considered. All applications submitted after this time will be taken into consideration only if there is space available.

Selection Criteria
The selection committee will review applications and inform applicants via email or phone on December 2nd – 4th, 2014. Individuals selected to participate are required to pay a $30 registration fee or submit a fee waiver with their application by November 16th, 2015 in order to keep their spot. Individuals not selected in the first round will be placed on a waiting list. Please note that if you have attended APILR before you must apply as a mentor to attend again (Different Application).

Registration Fee and Liability
If you are selected to attend there will be a participation fee of $30. Further instructions will be announced later regarding payment. You will be required to fill out the Waiver of Liability form when you submit your NON-REFUNDABLE and NON-TRANSFERABLE payment. Participation fees include transportation, room and board, and all retreat materials.

Itinerary
Friday. January 22nd, 2015: The bus will depart from UC Davis to the retreat site on Friday afternoon. The estimated time of arrival will depend on pending traffic. More details about departure will be given at a later time.
Sunday. January 24th, 2015: We will depart from the retreat site at approximately 2:00pm and should be back to the UC Davis campus no later than 4:00pm

Please Note
Students will not be permitted to drive themselves to the retreat site. You must travel via charter bus with the group, so please plan accordingly.

If you would like a letter verifying your participation for an academic or work related reason, please notify Fong Tran at: fntran@ucdavis.edu at least two weeks before you need the letter.


Contact Information
If you have any questions or please call the following contacts:

Mandy Lew
APILR/APCW Student Coordinator
mglew@ucdavis.edu

Katelyn Dixon
APILR/APCW Student Coordinator
kedixon@ucdavis.edu

Fong Tran
CCC Program Advisor/Coordinator
fntran@ucdavis.edu
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General Information
First Name *
MI
Last Name *
Email (UC Davis email preferred) *
Main Contact # *
School Year *
Main Contact # *
Gender *
Preferred Pronouns (she/he/they) *
Ethnicity *
Adoptee
Transfer Student
Affiliated Organizations *
List any orgs you have been a part of, including leadership roles if applicable
T-shirt Size *
Required
Sleeping and shower accommodations at this site are gender neutral. Will you need gender-specific accommodations? *
Required
Reduced Fee Waiver *
Reduced Fee Waivers are a way to help students with financial constraints pay for the cost of this retreat. If needed, explain your reason for requesting this waiver.)
Emergency Contact Information: Please list someone who is not also attending the retreat, and who would be able to make medical decisions for you in case of emergency.
Primary Emergency Contact *
Phone Number *
Relationship to Applicant *
Secondary Emergency Contact *
Phone Number *
Relationship to Applicant *
Health Information
Are there any health concerns/special needs that we should be aware of? *
If yes, please list them
Allergies to Food or Medications *
If yes, please list them
Do you have any dietary restrictions? *
Required
Please answer the following questions to the best of your ability.
What does your Asian Pacific Islander (API) identity mean to you? *
If you do not identify as API, what other identities do you connect with and why? (450 character minimum)
What do you think are important or salient issues(s) concerning the API community? *
(These can pertain to UC Davis or outside of UC Davis) (450 character minimum)
What do you hope to gain from APILR? How will you apply it to your experience here at UC Davis? *
(450 character minimum)
Please answer the following questions honestly
This section will help the coordinators plan the content for APILR. Your answers will not affect your eligibility in attending the retreat.  
How often do you think about your ethnicity? *
How often to you participate in the API community? *
(clubs, retreats, programs, etc. in high school or college)
Where did you hear about APILR?
If a faculty member (professor, etc.) informed you, please list their name
Have you applied to APILR before as a participant?
Have you attended other retreats such as SEA retreat, REACH retreat, etc.?
If yes, please list the retreats you have been to
Would you like to be added to the Cross Cultural Center's listserv in order to receive information about campus resources and events?
Statement of Agreement
If I am selected to participate, I agree to follow all University Policies and guidelines including support for the principles of community, abstaining from alcohol consumption, and engaging in the use of illegal drugs while attending the conference. Furthermore, I understand that I am committed to attending the entire retreat. Early departure will not be allowed unless there is an emergency.
Participant Signature *
(Write out full name)
Date *
By signing your name on the signature line, you verify yourself as the named applicant and agree to all information and policies outlined in this application.  **lf under 18 years of age, a signature of parent or guardian is necessary**
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