2019 Summer Academy Application
RequiredRequired Question(s)
It's important to recognize that as a part of the application process SEIU Healthcare will take into consideration your Academy experience and engagement participation when filling the limited spaces at the 2019 Summer Academy
 
1.
Please enter the information indicated below (All fields are mandatory)

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Address 1:
City:
State/Province
(US/Canada):
Postal Code:
Workplace:

Required 2.
Mobile Number:


 

50 characters left.
Required 3.
Sector you work in:
Long-term Care
Hospitals
Home and Community Care
Required 4.
I am:
a chief steward
a steward
not a steward
Required 5.

What role(s) have you played within SEIU Healthcare (pick all that apply):


Leading workplace campaigns, events, and actions
Health and Safety Committees
Bargaining Committees
Volunteered at an SEIU event (swag booth, registration, other roles)
Told my story (Profiled by SEIU Communications)
Recruited members for SEIU events and campaigns
Participated in SEIU's political action campaigns
Participated in an action / rally
None of the above
Other  
Required 6.

Do you self-identify with any of the following? (please choose all that apply)

LGBTQI2
Worker of Colour
Indigenous or Aboriginal
Women
Worker with Disability
Millennial Worker
None of the Above
Other  
Required 7.
Which of the following SEIU Healthcare education programs have you participated in? (please choose all that apply)
2016 Spring Leadership Academy
2016 Fall Leadership Academy
2017 Spring Leadership Academy
2017 Leadership Academy Summer School
2017 Fall Leadership Academy
2018 "Team Up" Canvassing Campaign
2018 Summer Academy
2018 Fall Academy
None Of The Above
  • Comment:

  • 500 characters left.
Required 8.
 Have you completed any of the SEIU Healthcare online education courses? 
Yes
No
Required 9.
Have you taken any of the following courses during the 2018 Summer or Fall Academies? (please choose all that apply)
Organizing Your Workplace
Mental Health
Facing Management
None of the Above
Required 10.

Rate the following courses in order of interest (1 means very interested and 4 means least interested):


(1 = Very Interested)
 
Organizing campaigns and actions in your workplace
Facing management and confidence when representing others
Media literacy and navigating system structures of power
Mental health and self-care
Required 11.

The Summer Academy will be an intensive four day event. We are providing LOAs, shared accommodations, and meals. Please note: roommate assignments will be random and roommate requests will not be accommodated.


The Summer Academy will include evening activities, and long days of learning and engagement. While some activities will be optional, do you agree to be present for all the required sessions?

Yes
No