Black Community Trust Fund Advisory Committee Application 2022

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Form

Nominator Form

Who are you nominating?

Nominee's First Name

Nominee's Last Name

Please Share Your Contact Information

First Name

Last Name

Preferred Name(s)

Please select which phone numbers you use

Cell Phone

Home Phone

Work Phone

Cell Phone

Home Phone

Work Phone

Best way to contact you

Mailing Address

Mailing Street

City

State

Please enter US state abbreviation

Zip Code

Tell Us More!

In a just economy, we know diversity towards common struggle is our best defense against predatory elements in our society. This starts with the multiple identities you bring into a space. This application helps us to ensure there is a diversity of identities in this space.

Disclaimer: The information provided will not be shared with external parties and will only be used for our internal application review process, assessing emergent needs, and preparing accommodations.

Race

Please share additional details about your race or ethnicity:

What is your age range?

Gender

cis man/woman: gender identity matches sex identified at birth

Additional Gender Details

Do you identify as LGBTQIA+ ?

If you selected "Other" for LGBTQIA+, you are welcome to elaborate if you'd like:

Pronouns

If you selected "Multiple" please let us know your Pronouns:

Faith/Religion/Spirituality

If you selected "Other Religion" please list your religion here, if you'd like:

What is your highest level of education?

If you selected "Other", please list your education here, if you'd like:

Access and Accomodations

Please select all accommodations you would need to facilitate your participation (select all that apply):

Please elaborate on the accommodations that would help facilitate your participations (ex: language for translation, other needs not listed above):

2022 Program Dates

The advisory committee will meet twice a month. Please select which of the following times work for you.

Weekday - MorningWeekday - EveningWeekend - MorningI am not available at any of the above times

If you are unavailable during the offered times, please tell us more about your situation:

Nominator Narrative Responses

Would you like to submit the rest of your nomination as written narrative responses or as video narrative?

Written NarrativeVideo Responses

Written Narrative Responses

What gifts, attributes, or experiences would they add to the advisory committee

How would you describe them ( personality, traits. etc) ?

Why do you think they would be a good fit for this role?

Anything else we should know about them?

Video Nomination

Please record a video that answers the following questions about the person you are nominating.

What gifts, attributes, or experiences would they add to the advisory committee?
How would you describe them ( personality, traits. etc) ?
Why do you think they would be a good fit for this role?
Anything else we should know about them? (optional)

Please upload your video to your preferred video or file platform (like YouTube, Vimeo, DropBox, etc) and share the link to your video with us below.

Link to your nomination video

Code to access video, if applicable

Application Narrative Responses

Would you like to submit the rest of your application as written narrative responses or as video narrative?

Written NarrativeVideo Responses

Written Narrative Responses

Why are you interested in serving as an advisory committee member?

What excites you about serving on the committee and why do you think it's important?

What life experiences, skills, or gift would you bring to the committee AND do you have any experience with this type of work?

Please share your history, and lineage in your communities. Are you a newcomer to MN, ND, SD or has your family been in this geographic community for generations, or maybe somewhere in between?

What does Black Wealth mean to you and your community?

Why would our Black communities want to nominate you?

Video Application

Please record a video that answers the following questions

Why are you interested in serving as an advisory committee member?
What excites you about serving on the committee and why do you think it's important?
What life experiences, skills, or gift would you bring to the committee AND do you have any experience with this type of work?
Please share your history, and lineage in your communities. Are you a newcomer to MN, ND, SD or has your family been in this geographic community for generations, or maybe somewhere in between?
What does Black Wealth mean to you and your community?
Why would our Black communities want to nominate you?

Please upload your video to your preferred video or file platform (like YouTube, Vimeo, DropBox, etc) and share the link to your video with us below.

Link to your application video

Code to access video, if applicable

Do you need help with finding someone to nominate you? ( Nomination can be someone who can speak to your values, gifts, and experience you will bring to the committee; nominators can be family or friends).

YesNo

Would you like to upload any additional materials, such as a personal statement, art, poem, etc?

Status

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