Civics 101 Workshop Registration

Welcome to The 2022 Civics 101 Workshop!

Civics 101 is a FREE 2-day community workshop series focused on building community power through civic knowledge! The 2022 Civics 101 Workshop will be held at the University of Bridgeport on Saturday, May 21st and Sunday, May 22nd. Please register by completing the form below! (¡Por favor regístrese aquí!)

Name/ Nombre*

First Last

Email*

Address / Dirección*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If you live in Bridgeport, what neighborhood do you live in? / Si vive en Bridgeport, ¿en qué vecindario vive?*

Phone / Teléfono

What is your race? / ¿Cuál es su raza?*

What is your ethnicity? / Cuál es tu etnia?*

How old are you? / ¿Cuántos años tienes?*

Which day are you registering for? (check all that apply) / ¿Para qué día te registras? (marque todo lo que corresponda)*

Saturday / Sabado May 21st: 10:00am - 5:00pm
Sunday/ Domingo May 22nd: 12:00pm - 4:00pm
Both Saturday & Sunday / Los dos dias

How did you hear about this event? (check all that apply) / ¿Cómo te enteraste acerca de este evento? (marque todo lo que corresponda)*

Bridgeport Generation Now Meeting / Reunión
Facebook
Social Media / Medios de comunicación social
Email
Word of Mouth / De un amigo

Which of the following best describes you? / ¿Cuál de las siguientes te describe mejor?*

I'm a Core Member / Soy un Core Member
I'm a General Member / Soy un General Member
I'm currently an elected official, serve on a Bridgeport Board or Commission and/or work for the city of Bridgeport / soy un funcionario electo, sirvo en una junta o comisión de Bridgeport y/o trabajo para la ciudad de Bridgeport
I'm interested in running for public office in Bridgeport / Estoy interesado en postularme para un cargo público
I'm a member of a group with a political agenda / Soy miembro de un grupo con una agenda política
I'm a member of a group working to address community issues / Soy miembro de un grupo que trabaja para abordar los problemas de la comunidad
I'm a general citizen interested in learning more about Bridgeport / Soy un ciudadano general interesado en aprender más sobre Bridgeport

Current Civil Servant

What position do you currently hold in Bridgeport's government?

If you feel comfortable doing so, please use the space below to briefly discuss some improvements you'd like to see made within Bridgeport government. (Your responses will be kept confidential).

May we contact you for more feedback on Bridgeport's government?*

Yes
No

Phone*

Interest in Public Office

What office are you interested in running for?*

Have you previously run for or held office in Bridgeport?*

Yes
No

If you have run for office (with or without holding office), please use the space below to discuss the experience of running for office. What were some major challenges?

If you have previously held office in Bridgeport, please use the space below to list the office, term in office, and any major successes while in office. (You may skip this question if you have not held office).

Member of a Community / Political Group

What is the name of the organization that you are a part of? / ¿Cómo se llama la organización de la que forma parte?*

What are some issues your group works to address in Bridgeport? / ¿Cuáles son algunos de los problemas que su grupo trabaja para abordar en Bridgeport?*

Would you be interested in collaborating with Bridgeport Generation Now to address the issues you named above? / ¿Le interesaría colaborar con Bridgeport Generation Now para abordar los problemas?*

Yes
No

Additional Needs

Do you have any dietary requests? (Please list any food allergies in the "Other" box) / ¿Tienes alguna petición dietética?

Gluten-Free / Sin gluten
Vegan / Vegano
Vegetarian / Vegetariana

We will provide breakfast and lunch on Saturday and lunch on Sunday with general refreshments available both days, throughout the workshop.

Do you require childcare? / ¿Requieres cuidado de niños?*

Yes, Saturday / Si, sabado
Yes, Sunday / Si, domingo
Yes, both days / Si, los dos dias
No

We will arrange for on-site childcare with a childcare professional.

Do you require English > Spanish translation? / ¿Necesita traducción de inglés a español?*

Yes, Saturday / Si,sabado
Yes, Sunday / Si, domingo
Yes, both days / So, los dos dias
No

We will arrange for interpretation service .

Welcome to The 2022 Civics 101 Workshop!

Current Civil Servant

Interest in Public Office

Member of a Community / Political Group

Additional Needs

You are leaving Bridgeport Generation Now