Civic Assemblies Interest Survey
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Campus Compact and New America are joining forces to support Community Colleges in exploring and piloting civic assemblies. Please complete the form below to indicate your interest in joining a cohort of campuses that will embark on the integration of this new civic engagement method.
Organization Information
Section Description
Required: This information is
required
whenever individuals at colleges/universities are the primary audience for your form.
In which state/province is your institution located?
Select "Remote/Hybrid" if your organization is not based in a specific State/Province.
What is your institutional affiliation?
Choose the correct organization from the dropdown. If not listed, select "Not Listed" and type the name in the dialogue box that appears below.
Can't find the organization? Write it here.
Membership Status
Membership Status Defined
Pending Renewal:
Previously active member with a renewal invoice for the current fiscal year. Applied at the start of the fiscal year to institutions active in the previous one. [Current FY dues are still due.]
Active:
Member institution in good standing. Dues are paid and current.
Inactive:
Non-Member Institution.
Lapsed Commitment:
The institution committed to membership in the previous fiscal year, participated in a program for which membership was required (e.g. VISTA), but has not paid that year’s dues.
Consult with the membership team before discussing membership
or
admitting to any member-required program.
Application Information
Required: This information is
required.
Please change the text to the appropriate application type [options > placeholder]. It is
hidden
from end users.
Please confirm the Application Type, Program Cohort Name, and Program Name with Membership.
Application Type
Program Cohort
Program Program
Primary Contact Information
Required: This information is
required
and is pulled directly from Salesforce. It is
hidden
from end users.
President/Chancellor
President/Chancellor
President/Chancellor Title
President/Chancellor Email
Campus Champion
Campus Champion
Campus Champion Title
Campus Champion Email
State 2 Digit
Account ID
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Contact Information
Section Description
Please do not remove any of the required questions in this section from your application. These are designed to help us build out profiles on the people involved in our programs.
First Name
Last Name
Primary Role
Please select...
Academic Dean
Campus Compact Staff
Chief Academic Officer
Chief Administrator (CEO)
Chief Community Engagement Officer
Chief Diversity, Equity, Inclusion Officer
Chief Governmental Affairs Officer
Chief Student Affairs Officer
Community Engagement Professional
Community Partner
Faculty/Instructor
Student
Staff
Other
Please select the options that most accurately describes your current role.
Title
Students are welcome to include a title that's important to them (e.g. Student Government President) or to simply type "student".
Email
Phone Number
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What is your experience with Citizen Assemblies?
Brand new to it
I've heard of it, but never experienced or worked on directly
I've engaged directly with a citizen assembly before
Would you be interested in working with New America and Campus Compact to organize a civic assembly-inspired event at your community college?
Yes
No
If yes, please include the name, title and email addresses of any colleagues that we should include in our follow ups
What opportunities do you see for citizen assemblies for your campus/community?
What roles might your students be interested in playing in the assembly process (as facilitators, participants, designers, etc.)?
What roadblocks or challenges exist for getting a citizen assembly off the ground at your institution?
What support or resources would be most beneficial to you? (Select all that apply)
Technical assistance to guide me through the process
A community of practice with others exploring this so we can share and learn together
Funding to help resource the operations of the assembly
Recognition at my campus for my participation (for example being named as part of a national cohort)
Anything else you'd like to share with us?