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I am a PSAC B.C. member who self-identifies as Racially Visible. *

A racially visible person in Canada is non-white in colour or race, regardless of place of birth. Only members who self-identify as Racially Visible can attend this conference. For further clarification of Racially Visible groups, please see “Equity Group Identification” section below.

Personal information

Name *

First

Last

Email *

Personal, not employer email please

PSAC ID number *

Cell phone *

or your home phone number if no cell

Work phone *

Home address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Workplace information

Component / DCL *

Local / Branch number *

Worksite address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

if you’re working remotely due to Covid, enter your usual or pre-pandemic workplace

Participant Profile

Important note: The responses to these questions will be used in the selection process for participants and observers to the conference.

To ensure that the conference responds to the needs of our members, we invite you to complete the following questions.

This is my first PSAC Conference *

If you have recently attended other PSAC Events (such as conferences, courses, etc.) please list which events and describe how this has impacted your union activism.

I am a leader or member of a PSAC Regional and/or Component Human Rights or Racially Visible Committee?

I am active on Racially Visible workers’ rights in my union or workplace and/or active in the community on Racially Visible issues.

If you are chosen as a participant at this Conference, how would this experience lead to help you advance Racially Visible leadership and engagement in your workplace, Local, Region, Component, and/or in your community? *

Equity self-ID

PSAC members who belong to the following groups are invited to self-identify. This information is voluntary and kept confidential and will be used for the purposes of supporting our equity initiatives and programs. Please check all that apply.

I am racially visible *

A racially visible person in Canada is non-white in colour or race, regardless of place of birth.

I am 35 years of age and under

I am a member of the 2SLGBTQIA+ community

Two-Spirited, Lesbian, Gay, Bisexual, Transgender Persons, Queer, Intersex, Asexual

I self-identify as a woman

I am a person with a disability

For equity purposes, “person with disabilities” means persons who experience barriers arising from impairments of a physical, mental, sensory, psychiatric or learning nature.

I am an Indigenous person

PSAC Contact Lists

Please add my name and contact information to one or more of our respective PSAC Equity and other PSAC Regional Committee contact lists.
Please add my name and contact information to the PSAC B.C. Regional Newsletter distribution list.

Pronouns

Please indicate your pronouns (she, he, they, zhe, etc) below. More information on pronouns and building trans-inclusive workspaces can be found here.

Loss of salary and expenses

The following information will only be used if you are selected as a participant to the conference.

Please identify if you will require loss of salary to be covered. In most cases, a full day will be needed to arrive in time for the program on Friday.

If you require Loss of Salary for Saturday or Sunday, please indicate below (for budget tracking purposes).

If selected as a participant, I will require an advance for expenses (including loss of salary) associated with this Conference. *

Accommodation for disabilities

The following information will only be used if you are selected as a participant to the conference.

The PSAC Accommodation Policy strives to ensure that PSAC Conferences are barrier-free for members with disabilities. Once selected as a participant, members will be asked to specify their accommodation needs in order to facilitate their participation at this Conference.

I am a member with a disability and require accommodation.

You may be required to provide relevant medical documentation that will assist us to respond to your request. This information will not be disclosed except where necessary to respond to your request for accommodation.

If you have dietary requirements or allergies that the PSAC should be aware of, specify them here

Family care

The objective of the PSAC Family Care Policy is to remove one of the barriers which prevents members from participating fully in Union activities and which provides for the reimbursement of family care expenses. A copy of the policy is available on the PSAC website at www.psacunion.ca/family-care-policy.

On-site childcare is intended to remove a barrier to participation at the Conference and is provided only for those who could not otherwise attend, had the service not been available. Requests must be received no later than Monday January 30, 2023.

If there are any requests by participants, on-site childcare will be provided at the Conference for the activities outlined in the agenda.

I require on-site child care

Mode of Transportation

Please indicate your preferred mode of travel. Participants are expected to travel by the most direct, economical means.

Details

Please provide any relevant details here.

Emergency contact

Name

Emergency contact phone number

Last Section

Is there anything else you would like to add to your application?

With this application, I agree that, if selected, I will attend and participate in all sessions of the PSAC B.C. Regional Racially Visible Member’s Conference scheduled for Friday to Sunday, March 17, 18, & 19, 2023.