- Anticipated Total
Anticipated total amount over the full term of this award.
- Supplemental Questions
- What are your gender pronouns?
- Please list all degrees (as abbreviated e.g. AA/AS, BA/BS)
- Please select your current learner affiliation:
- If applicable, please share your current academic program affiliation:
- Please select your current campus affiliation:
- Cell Phone Number
- Please upload a CV or resume
- Please provide a brief biography:
- Why are you interested in becoming a DEI Ambassador?
- List and describe three of your attributes that would contribute to being an excellent Ambassador?
- What does diversity, equity and inclusion mean to you?
- Please upload here one personal letter of recommendation or email to firstname.lastname@example.org
- Please upload one professional letter of recommendation or email to email@example.com
- Do you require any reasonable accommodations?
- If I am selected as a DEI Ambassador (the "Ambassador"), I give permission to the University of Kansas (the "University") and the University of Kansas Medical Center to use the information provided in this REDCap survey, including my photo and information included in my "Bio," for purposes of marketing and promoting the Ambassador role. I understand and agree that these marketing and promotional efforts may include, but are not limited to, videos, media articles, newsletters, brochures, websites, and annual reports posted on University-managed information resources and/or in print, as well as posts on social media platforms, such as Facebook, Twitter, and Instagram, managed by the University.
- If I am selected to participate as an Ambassador, I consent to have my interview and other program-related convenings recorded (audio and visual) by the University. I grant the University a non-exclusive, royalty-free right to edit, use, and reproduce the recording of the interview and other program-related convenings for promotional and non-commercial purposes, including, but not limited to, inclusion on the websites of the University's Office of International Programs. I understand that I am responsible for obtaining permission to use any materials from the interview and other program-related convenings (including films, slides, evaluation instruments, etc.) copyrighted by any other individual or organization.
I waive all rights and agree to indemnify and hold harmless the University of Kansas (including it University of Kansas Medical Center), its affiliates, the Kansas Board of Regents, and the State of Kansas, and their respective employees, agents, and members, and will neither sue nor bring any proceeding against them, for any claim, demand, cause of action, compensation, royalties or damages based upon or relating to the University's use of the interview and program-related convenings consistent with the preceding permission and release.
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