Retaining Diverse Talent in Environmental Careers and Organizations
Resources for Measuring Success

February 23, 2015
3:00 pm – 5:30 pm
Followed by networking dinner

Marian Koshland Science Museum
of the National Academy of Sciences
525 E Street, NW
Washington, DC

A Workshop for Foundations and Agencies
Seeking to develop the next generation of environmental professionals

SPEAKERS

Kelly Brown, Director, D5 Coalition
Jeramie Strickland, Wildlife Biologist, US Fish and Wildlife Service

Learn more about our speakers

The workshop will present key factors for the diversity gap in environmental and science fields, case studies of successful diversity models, and a framework for program metrics. Participants will have time to work with your peers to develop a preliminary rubric of metrics suited to your organization’s programs.

WALK AWAY WITH

1. Critical perspectives on diversity issues
2. Listing of relevant studies, programs and resources
3. A rubric of metrics to assess diversity-focused proposals and programs
4. A community of peers interested in advancing a diversity strategy

PLEASE REGISTER BELOW

SEEDS Participant Information Sheet

Contact Information

ATTENTION: The contact information you provide below will be used by the SEEDS program to relay important trip information and travel arrangements. Please provide accurate information for points of contact that will checked regularly and replied to promptly.

Name: *

As it appears on your Government ID

Middle Name:

Last Name: *

As it appears on your Government ID

Gender: *

Date of Birth: mm/dd/yyyy *

Race / Ethnicity *

This information is ONLY for the SEEDS program.

Academic Institution *

Academic Year *

Expected Graduation: (mm/yyyy) *

Please specify gender:

Please specify race or ethnicity

Mailing Address: *

Mailing Address 2:

City: *

Zip Code *

Cell Phone: xxx-xxx-xxxx *

State *

Telephone Number: xxx-xxx-xxxx

Personal Email Address: *

School Email Address:

Short Biography

Please write a short paragraph about yourself to share with the rest of the student participants. Introduce yourself, your academic and personal interests and any other cool facts about yourself that you would like to share. This information will be sent our to all participants before the meeting.

Short Biography *

Personal Considerations

The SEEDS program is a minority serving program. The information that you provide is used to measure our programs efforts to increase minority representation within the science of ecology. The information is for SEEDS program use only and is not shared or sold. We appreciate your help!

Are you a first generation college student? *

Yes

Are your eligible for the Federal PELL Grant Program? *

Yes

Are you a veteran of the U.S. Armed Forces? *

Yes

Are you affiliated with a federally-recognized tribe? *

Yes

Are you a tribal member?

Yes

Name of tribe: *

How would you like your name to appear on the name badge? *

Medical Information

Medical information is collected for emergency use only. In case of an emergency, this information will he shared with medical care providers and the emergency contact will be notified as soon as possible.

Primary Medical Care Provider: clinic or physicians name *

Provider Phone Number: xxx-xxx-xxxx *

Do you have medical insurance? *

Yes

Insurance Carrier Name: *

Policy Number: *

Do you have any health issues that we should be aware of? *

Yes

Please describe health issue: *

Do you have any known medication allergies? *

Yes

Are you allergic to any medication?

Please describe medication allergy:

Include medications and derivatives.

Do you have any chronic disability or illness? (past or present) *

Yes

Please describe: *

Are you physically challenged and/or requiere special assistance or services? *

Yes

Please describe: *

Are you currently taking any medications? *

Yes

Please list each medication and its use: *

Do you have any dietary restrictions or food allergies? *

Yes

Food is provided by SEEDS and we make all the arrangement for dietary needs, food allergies or intolerance.

Please describe: *

Emergency Contact

Full Name: First and Last *

Relationship to you: Parent, Spouse, Partner *

Mailing Address: *

Mailing Address 2:

City *

State *

Zip Code *

Cell Phone: xxx-xxx-xxxx *

Alternate Phone: xxx-xxx-xxxx

Email Address: *

Accident Waiver and Release of Responsibility

2017 SEEDS Leadership Meeting

El Yunque National Forest

April 5-9, 2017

I acknowledge that this activity or event is a test of a person's physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to participants, but are also present for volunteers.

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault.

I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity or event.

I acknowledge that this Accident Waiver and Release of Liability form will be used by the event holders, sponsors and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event.

In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS:

The Ecological Society of America, Inc., its directors, officers, employees, volunteers, representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers;

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise.

I acknowledge that the Ecological Society of America and its directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf of the Ecological Society of America.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during this activity or event.

I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns.

The accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT; AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

Full Name: *

Age: *

Date: mm/dd/yyyy *

Travel Policy Agreement

2017 SEEDS Leadership Meeting

El Yunque National Forest

April 5-9, 2017

I HEREBY AGREE TO THE FOLLOWING:

I will be responsible for the cost of travel arrangements that are not booked through the Ecological Society of America’s travel agent.

I will be responsible for the cost of travel arrangements made after the designated program deadline.

I will be responsible for any travel arrangement costs that exceed round-trip travel between my local airport and the specified destination.

I will be responsible for any costs that might be incurred as a result of changing my travel arrangements once they have been made.

I will be responsible for any expenses that cannot be recouped if I cancel a reservation for any reason deemed foreseeable.

I will be responsible for any expenses that might be incurred due to airline fees for checked luggage.

ESA-SEEDS Program is a drug free environment, I will be held accountable for any expenses if I am found in possession of or under the influence of any illegal drug under federal law.

In the event of emergency or illness, I must cancel my reservation before the time of departure in order to receive credit for the ticket cost. This credit will be applied for future SEEDS program travel.

I CERTIFY THAT I HAVE READ THIS DOCUMENT; AND I FULLY UNDERSTAND ITS CONTENT.

Full Name: *

Age: *

Date: mm/dd/yyyy *

Participant Certification

I have read and checked this form for omissions and errors. To the best of my knowledge, the information is complete and correct. I understand that the inclusion by me of false information or the failure to report all information requested in this application could disqualify me for further opportunities with the Ecological Society of America's SEEDS Program.

Do you agree? *

Yes

Retaining Diverse Talent in Environmental Careers and Organizations Resources for Measuring Success

SPEAKERS

WALK AWAY WITH

PLEASE REGISTER BELOW

SEEDS Participant Information Sheet

Contact Information

Short Biography

Personal Considerations

Medical Information

Emergency Contact

Accident Waiver and Release of Responsibility

2017 SEEDS Leadership Meeting

El Yunque National Forest

April 5-9, 2017

Travel Policy Agreement

2017 SEEDS Leadership Meeting

El Yunque National Forest

April 5-9, 2017

Participant Certification

Retaining Diverse Talent in Environmental Careers and Organizations
Resources for Measuring Success