Nomination Form:
Peretz Anti-Racism Community Task Force

The deadline has passed! Thank you for your interest.

The Peretz Centre is calling for nominations for appointed members of our Anti-Racism Community Task Force, a key part of the Discovering Doikayt initiative. Self-nominations are encouraged and welcomed.

Before submitting this form, please review the call for nominations here.

Deadline: Monday, September 15, 2025

Nominee Information

Full name of nominee

Pronouns (optional)

Phone

What will the nominee bring to the Task Force? (1-2 sentences about lived experience, perspective, or skills related to project goals)

How will the nominee contribute? (A short note on their willingness to work with others and put in the time for meetings and policy recommendations)

Advisory role: If not selected as one of the 5 stipend-supported members, would the nominee consider joining as a volunteer advisor?

Accessibility: Would the nominee benefit from accommodations or additional support to participate (like accessibility, childcare, transportation, translation, etc.)

We may not be able to accommodate all needs but will do our best!

Is the nominee a Peretz member in good standing (paid membership dues in the current year)?

Yes

Not sure

Other comments (optional)