2017 Community Oregon Application

 

Congratulations! You have been nominated to apply for the 2017 Community Oregon program. Please complete the information below if you wish to accept your nomination. Because Community Oregon will accept more applications than available slots in the program, you will be notified by June 1st regarding the status of your application for the program.

* = required field

 

1. Nominee Contact Info


Work









 

Home







 

Please check which address you would like mail sent to.*
WorkHome
Please check which address you would like email sent to.*

 

2. Nominee Personal/Demographic Information

Community Oregon seeks to include a broad range of Oregonians in this program in order to increase potential learning opportunities. While completion of the following section helps us ensure that we include participants from among the widest sample of Oregon residents as possible, you may skip a question if it causes you undue discomfort. This information is for internal purposes only and will not be shared without permission. Thank you!

How would you describe where you live?
UrbanRuralSuburbanOther:






 
Frequency of Religious Practice
FrequentOccasional/InfrequentN/A
 
Educational Attainment
High School DiplomaSome College or Community CollegeCollege DegreeOther:

 

3. Nominee Biography

 

4. Nominee Statement of Interest

 

5. Nominee Photo

Please upload a photo of yourself.*

 

6. Participation Agreement

I. PROGRAM OBJECTIVE
Community Oregon is a program of Healthy Democracy designed as a response to the need to increase understanding and communication among diverse segments of Oregon’s electorate. Community Oregon will offer opportunities to create stronger relationships among the state’s citizenry in a way that will help build and sustain a healthier democracy in Oregon.

II. PROGRAM LOGISTICS
The program consists of:

  1. Community Oregon Camp - a 3 day retreat taking place from noon on Thursday, July 13 to noon on Sunday, July 16 at Kah-Nee-Ta Resort in Warm Springs, Oregon.
  2. Community Oregon Exchange – an opportunity for immersion in a community significantly different than yours. One urban to rural, and one rural to urban community visit will take place between 6-10 weeks following the Community Oregon Camp retreat. The venue and format of the exchange phase of the program will be determined primarily by Community Oregon program participants themselves with assistance from Healthy Democracy staff as needed. Logistics will be fully supported by Healthy Democracy staff.
  3. Community Oregon Expo – a one day exposition to take place in the Portland area in the fall (November 2017) that will include all Community Oregon participants and a number of special invitees. The purpose will be to showcase what you’ve learned and invite support for any collaborative projects that Community Oregon participants wish to develop or support as a result of their experience with the program.

Community Oregon participants will be reimbursed for all travel to the Community Oregon Camp, the Community Oregon Exchange, and the Community Oregon Expo . Expenses for accommodations for the Community Oregon Camp and the fall Expo (for those needing hotels) are also covered. Overnight accommodations for the Urban/Rural Exchanges will be comprised of host community homestays.

III. ATTENDANCE
Community Oregon participants agree to commit to l00% attendance at all of the above program segments unless prevented from doing so by an emergency. This attendance policy is very important to the success of the program, so please give it careful consideration.

IV. HEALTHY DEMOCRACY IS A NON-PARTISAN ORGANIZATION
When engaged in partisan political activity, Community Oregon participants agree to avoid any reference to Healthy Democracy that could be construed as an endorsement by Healthy Democracy or the Community Oregon program.

* * * * * *

By typing your full name below, you acknowledge that you have read and understand these conditions of participation, and that you agree to abide by them if selected as part of the Community Oregon program.