Listening to the City: Registration

Facilitator Registration

To volunteer as a facilitator, please complete the form below.

Before you proceed, please be sure that you have reviewed the Required Skills and Required Commitment sections of the Volunteer Facilitator section of the website.

If you have any questions or need more information before volunteering, please send an email to facilitators@listeningtothecity.org.

* required field

Salutation:

First Name:*

Middle Name:

Last Name:*

Company/Organization:

Address:*

City:*

State:*

Use 'ZZ' for international addresses

Zip Code:*

Country:*

Phone (Primary):*

Phone (secondary):

Fax:

E-mail:*

Skills and Experience
Referred by (name or organization):



Do you have experience as a facilitator for an AmericaSpeaks program?:* Yes No
If yes, where? City: City:

Languages (other than English) in which you are fluent:

Do you have experience facilitating with a translator?: Yes No
In a few words, please describe your experience as a facilitator (limit to 30 words):



Demographic Information


Any demographic information you provide will remain confidential. Demographic information will be used only for the purposes of ensuring the greatest possible diversity among participants.

Gender: Male Female
Age:

What is your racial background? Are you:

Do you consider yourself Hispanic or Latino?: Yes No

By submitting this registration form, you assure us you have the required skills and can make the commitments outlined at the website.