Carbondale "At the Table"
Earth Month - April Dinner & Dialogue Series
About the Event:
The Carbondale "At the Table" Dinner & Dialogue Series will be held on April 7th at the Carbondale Civic Center. Doors will open at 5pm. From 5:30-7:00pm, community members from diverse backgrounds will come together to celebrate Earth Month through this month's event theme "This Land is Your Land: Stewardship, Stories, and Shared Spaces" while enjoying a community meal. This event is free and open to the public. Seating is limited. Please fill out the form below to let us know you are coming and tell our host a little bit more about yourself. *Only your name and contact information are required. PLEASE NOTE - The additional demographic information requested is to assist with the grant reporting process. Thank you to Brian Croft, Director of Sustainability and Touch of Nature Outdoor Education at SIUC for joining the Cit of Carbondale in celebrating Earth Month. Please email any additional questions to Dianah McGreehan at dmcgreehan@carbondaleil.gov
About the Healing Illinois Initiative
Healing Illinois is a racial healing initiative by the Illinois Department of Human Services (IDHS) in partnership with the Field Foundation of Illinois and the Southern Illinois Community Foundation. The initiative targets Racial Healing Sustainability & Readiness, Narrative Change, and Education & Training to promote dialogue, encourage collaboration, facilitate learning, and seed connections to strengthen communities across Illinois.
Name
*
First Name
Last Name
Email (or phone number if preferred)
*
example@example.com
What county do you currently reside?
What is your current zip code?
Age
17 years or younger
18-24
25-34
35-44
45-54
55-64
65 or older
Race/Ethnicity
Black/African American
Hispanic/Latino/a/x
White
Asian or Asian American
Pacific Islander/Native Hawaiian
American Indian/Alaska Native
Two or more races
Prefer not to say
Gender Identity
Woman
Man
Transgender/Trans Woman
Transgender/Trans Man
Non-binary
Prefer not to say
Other
Preferred Pronouns
She/Her/Hers
He/Him/His
They/Them/Their
Prefer not to say
Other
Where do you feel you are in your racial healing journey right now?
Just beginning
Actively learning/unlearning
Engaged in healing practices
Facilitating or leading others
Other
Is this the first Healing Illinois funded program you have attended?
Yes
No
Have you previously participated in other racial healing, racial equity, or restorative justice spaces?
Yes, as a participant
Yes, as a facilitator/practitioner
Yes, as both a participant and facilitator
No
Are you attending primarily as:
A community member
A professional/organizational representative
Other
Would you be interested in serving as a facilitator/volunteer in the future?
Yes
No
Not at this time maybe in the future
Please list any dietary restrictions you have OR note none
If you are bringing any other guests, please indicate the number of guests you are bringing and/or provide their name(s)
How did you hear about this event?
Social media
Email/newsletter
Word of mouth
Professional/Personal network
Outreach from hosting organization
Other
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