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  1. University of Arkansas for Medical Sciences
  2. Division for Diversity, Equity, and Inclusion
  3. Initiatives
  4. Office of Intercultural Education
  5. Academy for Inclusive Excellence
  6. NWA UAMS S.E.E.D. PROJECT
  7. 2021-2022 NW SEED Confirmation Form

2021-2022 NW SEED Confirmation Form

2021-2022 NW SEED Participant Confirmation

In an effort to optimize your experience in the 2021-2022 S.E.E.D. program, please complete the following questions. Please note: completion of this form serves as a confirmation of intent to complete the program. Please complete the form by November 4, 2021
Name
Please share. Example: Name: Amber Preferred Name: Nicole Personal Pronouns: She/Her
Gender Identity/Gender Expression
Gender Expression (GE). The external manifestations of gender, expressed through such things as names, pronouns, clothing, haircuts, behavior, voice, body characteristics, and more. Gender Identity (GI). One’s internal, deeply held sense of gender. Some people identify completely with the gender they were assigned at birth (usually male or female), while others may identify with only a part of that gender, or not at all. Some people identify with another gender entirely. Unlike gender expression, gender identity is not visible to others.

Select your racial identity
For many people, it comes as a surprise that racial categorization schemes were invented by scientists to support worldviews that viewed some groups of people as superior and some as inferior. • Race is a made-up social construct, and not an actual biological fact Racial Identity- An individual's awareness and experience of being a member of a racial and ethnic group; the racial and ethnic categories that an individual chooses to describe him or herself based on such factors as biological heritage, physical appearance, cultural affiliation, early socialization, and personal experience.

Please list your current department and position.
Do you have any dietary restrictions/allergies?
SEED will provide heavy horsd’oeuvres for each session. If you have any dietary restrictions please share. We are happy to accommodate to the best of our ability.

Please share your dietary restrictions/allergies.
Will you need any accommodations for our virtual sessions?
Example: Captioning, Large print PowerPoint, etc.

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Phone: (501) 686-7000
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