New England Grassroots Environment Fund · REGISTRATION: Grassroots Solutions Roundtable

Contact Information

Name

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First Name

Last Name

Email

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Verify Email

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Organization/Employer/Affiliation/School (if no affiliation, you can also write "community member")

*

What pronoun do you prefer to use? (i.e. she, he, they, etc.)

*

Are you comfortable with us sharing your contact information (name, affiliation, county, & email) with other attendees of the event?

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Yes

No

Your Perspective

Other:

What are you most passionate about? (in 4 words or less!)

This will be included on your name badge to facilitate networking at the event.

Is there anything else you would like to share about the perspective you bring?

Which of the following formats would provide the best way to share your perspective during the event?

Small group discussions

Large group discussions

In writing

Other:

Do you have other suggestions for structuring the event to ensure all voices are heard?

Maine Grassroots Sustainability Solutions Fund

Funding through the Maine Grassroots Solutions Fund will be available to grassroots groups through the New England Grassroots Environment Fund's Seed (up to $1,000), Grow (up to $3,500), and Young Adult Leaders (up to $7,500) Programs. You can find out more information about these programs and minimum eligibility guidelines here: https://grassrootsfund.org/dollars.

Are you interested in applying to the Maine Grassroots Sustainability Solutions Fund?

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Yes

No

Maybe, I'm not sure

Are you interested in reviewing grant applications to the Grassroots Sustainability Solutions Fund (you can both apply to the Fund and serve as a reviewer as we will avoid conflicts by not assigning you to review your own application).

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Yes, I will sign up here!: https://grassrootsfund.org/dollars

No, thank you.

Maybe, I will decide after the meeting.

Dietary Restrictions

We will be providing lunch at the event. Please let us know if you have any dietary restrictions/preferences.

Gluten Free

Vegan

Vegetarian

Sugar Free

Dairy Free

Other:

Participation Support

We strive to lower barriers to attendance at the event. Please let us know if there is anything that will help you participate. We will do our best to provide support and reimbursement on an as-needed basis and as funding allows. A Grassroots Fund staff member will follow up to confirm if funding is available or discuss your request.

Are you interested in carpooling to the event?

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Yes, I will find my carpool buddy here: https://www.groupcarpool.com/t/0xjzgm

No, thank you

Will you need any financial support to allow you to participate in the event?

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Yes

No

If yes, what kind of support do you need?

Travel reimbursement (We can reimburse at $0.545 per mile within our budget)

Childcare reimbursement

Stipend for missed work

Other (please list below)

Other:

What is the total amount you expect to need? Please breakdown the expenses if multiple types of support are requested.

Do you require translation to participate?

Yes

No

If yes, what language?

Is there anything else that would help you participate?