SEED Participant Information Sheet

Name

First Last

Choose a campus location

UAMS Main Campus

UAMS NWA Campus

Preferred Name and Personal Pronouns:

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.

White

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

Bi-racial/multi-racial

Other

Current Department/Position

Please list your current department and position.

Will you need any accommodations for our virtual sessions?

Example: Captioning, Large print PowerPoint, etc.

Yes

Other