Climate Stewards Application - Summer Course 2021 Basic InformationName* First Last Affiliation (if any) Email* Phone*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about the course?* newsletter newspaper flyer friend social media What do you hope to learn in this course?*Course requirements include reading the textbook and online modules, an email account, classroom lectures (Class sessions will be held via Zoom and/or in person (as allowable) at CEC HQ, 1219 State Street on Wednesday evenings from 6:30-9:00pm). There will be field trips that may require standing or walking on unpaved, uneven ground at a slow pace, potentially up and down hills for about a mile per field trip. There may be no access to bathrooms for up to four hours.Do you need accommodations to participate?* No Yes If 'yes', please describe so that we may follow up with you.Are you requesting a scholarship?* None Full Partial ConsentAttendance Policy* I understand and agree to the Attendance Policy.Participants must complete [minimum of 40+] hours of instruction during the class. Only one class session (2 hours) can be missed and participants can request a make-up session or assignment from their instructor. Cancellation/Refund Policy* I understand and agree to the cancellation/refund policy.Registrants may cancel up to two weeks before the first day of instruction for a full refund, minus a $50 administrative fee. Registrants that can successfully refer another student to replace their spot in the course prior to the first day of class will receive a full refund. Registrants that experience a verifiable medical emergency personally, or in their family, between the two weeks of class before and after instruction has begun may re-enroll in the following year's course at a 50% discounted rate, with priority for early registration. No other cancellations, for any other reason, will result in a refund.Non-Discrimination Policy* I understand and agree to the non-discrimination policy.University of California Non-discrimination policy (link)About YouThank you for taking the time to voluntarily identify your gender, ethnicity & race. We recognize that this information is private (between the UC Climate Stewards admins and CEC), and we assure you that the information collected is not shared publicly. It is used anonymously for reporting reasons and capturing this information helps us and the UC Climate Stewards program create a more inclusive and relevant learning environment, identify where we can make improvements in our programing to better serve all community members, and helps to secure funding specific to traditionally under-resourced communities. EthnicityHispanic or LatinoNot Hispanic or LatinoPrefer not to stateRaceAmerican Indian or Alaskan NativeAsian or Pacific IslanderBlack or African AmericanNative Hawaiian or other Pacific IslanderWhiteMore than one raceRace not listed abovePrefer not to state/undeterminedGenderFemaleMaleGender Identity not listed abovePrefer not to state/undeterminedSelf Described Ethnicity/Race/Gender IdentityPhoneThis field is for validation purposes and should be left unchanged.