Civil & Human Rights Committee Caucus MLDP Application
First Name
Last Name
Employer / Worksite
Home Email
Best Phone
Home City
Best Time to Reach You
Which Caucus(es) are you interested in representing?
AFRAM Caucus
Latinx caucus
lavender caucus
Indigenous Caucus
Asian Desi Pacific Islander Caucus
Womens Council
please check all languages that you speak fluently
Amharic
ASL (Sign Language)
Cantonese
Cantonese AND Mandarin
English
Haitian Creole
Hmong
Korean
Mandarin
Nepali
Other
Romanian
Russian
Somali
Spanish
Tagalog
Thai
Tigrinya
Toishanese
Vietnamese
Preferred / primary language
requirements for participants
I have a driver's license, car insurance, and a reliable car i can use
Yes
I have read and can meet all of the requirements of participation
Yes/No. If you need an accommodation please say so here.
How proficient are you with technology?
1
2
3
4
5
6
7
8
9
10
(1 = low proficiency, 10 = high proficiency)
(email, mapping apps, using handheld devices like iPads, etc)
How quickly do you learn new technology?
Very quickly
Quickly
Average
Takes me a while
It is very difficult for me to get used to new technology
Please describe your current union roles and activities
Please answer these questions in the space below:
1) what strengths would you bring to this program.
2) Why would you like to participate in the Member Leader Development Program?
3) What experience do you bring as a leader to this caucus from your worksite and or community?
How did you hear about the MLDP?
Please select...
Email
Text
Union Website
Facebook
Phone Call
My Organizer
Another SEIU Member
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