PRISM Advisory Member Application

Section 1: Personal Information(Required)

First Name Last Name Preferred Name Pronouns

Age(Required)

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address(Required)

City State / Province / Region ZIP / Postal Code Country

Do you identify as part of the 2SLGBTQIA+ community?(Required)

Please share how you identify:

If you do not identify as part of the 2SLGBTQIA+ community, please share why you would consider yourself a strong ally to the community?(Required)

Section 2: Background and Experience

Briefly Describe your education experience (if applicable):

Briefly describe your employment experience (if applicable):

Briefly describe your volunteer experience (if applicable):

Briefly describe any relevant personal or professional experience that you have with the 2SLGBTQIA+ community:(Required)

Please check the skills, expertise, or networks you are willing to contribute to the panel:(Required)

Strategic Planning

Fundraising/Development

Community Outreach

Marketing/Communications

Legal or Financial Expertise

Event Planning

Government or Policy Knowledge

Personal Experience

Section 3: Motivation and Commitment(Required)

Why are you interested in serving on the Pride, Respect, Identity, Safety and Mentoring (PRISM) Advisory Panel?

What are you hoping to gain from serving on the PRISM Advisory Panel?(Required)

What are a few topics you hope to discuss within the Panel?(Required)

When you do not share the same experience or opinion as someone else, how do you, or, how would you mediate the potential conflict?(Required)

Do you have any connections that would benefit the development of the PRISM Program?

Do you feel comfortable voting on program and agency related matters?(Required)

Yes

Why not?(Required)

Are you able to commit to once-a-month virtual Advisory Panel Meetings via Zoom or Microsoft Teams?(Required)

Yes

Are you able to commit to in-person meetings at an agreed upon place by the Panel one to three times a year?(Required)

Yes

Are you able to commit to being on the PRISM Advisory Panel for a year?(Required)

Yes

If you are not part of the 2SLGBTQIA+ community yourself, do you agree to participate in a way that that is agreed upon by the members of the Panel who do identify as part of the 2SLGBTQIA+ community?(Required)

Yes

Declaration

Mission Statement: The PRISM Advisory Panel is a group of members who contribute to the decision-making process of the new Pride, Respect, Identity, Safety, and Mentoring (PRISM) Program at Big Brothers Big Sisters of Peel York. The Panel’s professional, educational and personal experience will aid in the establishment of the PRISM program, ensuring its sustainability, efficacy and service impact. The PRISM Advisory Panel operates under the principals of valuing diversity, respecting the opinions and experiences of others, collaboration as a strength, and openness to continuous learning and understanding. All PRISM Advisory Members agree to these principles and understand that the decisions made on behalf of the PRISM Advisory Panel contribute to the wellbeing, support, and safety of the young people we serve and take this responsibility in the highest regard.

Do you agree to support the mission statement of the PRISM Advisory Panel?(Required)

Signature(Required)

This field is for validation purposes and should be left unchanged.

Welcome to the PRISM Advisory Panel Member Application Form

Declaration