Join the Resistance!
Name
Please provide a name that helps us check with your references.
What are your pronouns?
Email
example@example.com
Do you have your own transportation?
Yes
No
Do you have any physical accessibility needs?
Yes
No
Please elaborate so we can help accommodate you.
Phone (Please download the Signal app for more secure communication)
-
Area Code
Phone Number
Are you from the area?
Where are you coming from?
What dates/what is your timeline for being involved here?
Please list organizations you participate in.
Please list any skills you have or roles you can fill while at camp; eg direct action, jail support, media, hiking, camping, etc.
What experience do you have in the skills that you listed? Please be mindful of security.
What is your experience level with direct action? (Please don't give specifics that aren't safe to share!)
How did you hear about Appalachians Against Pipelines? Do you know anyone involved?
Trust
Your answers to these questions do not necessarily preclude you from working with us, but lying or withholding information regarding these questions will.
Have you ever collaborated with the state? (i.e. given information to police that incriminated others, revealed incriminating information in a court setting)
Yes
No
Please elaborate.
Have you ever worked for law enforcement or in the fossil fuel industry?
Yes
No
Please elaborate.
Have you been called in to an accountability process? If so, for what? Please give us a contact for someone on your accountability team.
Have you ever been called in to an accountability process?
Yes
No
Please elaborate and give us a contact for someone on your accountability team.
Is there anything else we should know regarding a history of harm or allegations of abusive behavior made against you?
Yes
No
Please elaborate.
References
Below, please list the names of 3 references, their phone numbers, and how many years you have known them. Preferably, these would be people you have known for more than 1 year, are not related to, and can speak to your trustworthiness and reliability.
Reference 1
Name, Phone Number, Years Known
Reference 2
Reference 3
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