Builders for Social Justice
January 22 - 24, 2027
With Marilyn Bugenhagen
...
...
*
These fields are required
1
Welcome
Please fill out your details and press Continue.
First Name
*
Please do NOT include any prefixes such as Sister/Father or Mr/Ms. You may include a preferred name in another question.
Last Name
*
Email
*
Save my progress and send me an email reminder
Continue
2
People in your group
Guest
1
First Name
*
Last Name
*
Email
*
Guest
1
First Name
*
Last Name
*
Email
*
After completing this form, emails will be sent to everyone in your group to complete their information.
Continue
3
Participant Info
Address
Address 2
City
State/Prov.
Other/International
Alabama
Alaska
Alberta
Arizona
Arkansas
Australian Capital Territory
British Columbia
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New South Wales
New York
Newfoundland
North Carolina
North Dakota
Northern Territory
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Quebec
Queensland
Rhode Island
Saskatchewan
South Australia
South Carolina
South Dakota
Tasmania
Tennessee
Texas
Utah
Vermont
Victoria
Virginia
Washington
West Virginia
Western Australia
Wisconsin
Wyoming
Yukon Territory
Zip/Postal
Country
United States
Canada
United Kingdom
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia And Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire (Ivory Coast)
Croatia (Hrvatska)
Cuba
Cyprus
Czech Republic
Democratic Republic Of Congo (Zaire)
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
France, Metropolitan
French Guinea
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard And McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Kitts And Nevis
Saint Lucia
Saint Vincent And The Grenadines
San Marino
Sao Tome And Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia And South Sandwich Islands
South Korea
Spain
Sri Lanka
Sudan
Suriname
Svalbard And Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City (Holy See)
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Wallis And Futuna Islands
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Phone
Please select the option that broadly characterizes your diet.
Omnivore (eats plants and meat)
Vegetarian (no meat or fish)
Vegan (no meat, dairy or other animal products)
There is a field below where you can share specific dietary needs, such as allergies & intolerances or variations such as pescatarian (eats fish but no other meat) or no pork/red meat.
Please share any food allergies or special dietary needs you may have. (Leave blank if none)
Please note that we make every effort to accommodate each person's dietary needs but highly specific diets may be outside of our ability to serve. We are not an allergy-safe kitchen. We have communal space on-site if you need to bring your own food items.
Special Needs (Accessibility / ADA)
Emergency Contact
Please list the name and phone number for someone who we can contact in case of emergency during your time on retreat.
How did you hear about this retreat?
Word of Mouth/Family or Friend
Siena Retreat Center's Website
Siena Retreat Center's E-Newsletter
Siena Retreat Center's Printed Catalogue
Siena Retreat Center's Social Media Accounts
Other Social Media
In-Person Tabling Event
Radio Ad
Print Ad
Other
Would you like to receive the e-newsletter from Siena Retreat Center?
Yes! Please add me to the email list!
Continue
4
Builders for Social Justice Application
Current Employer
What age group do you fall into?
18-29
30-39
40-49
50-59
60-69
70+
Gender
Male
Female
Transgender
Non-binary/non-conforming
How do you describe your race or ethnic background? (Check all that apply)
Asian or Asian American
Black or African American
Hispanic, Latino, or Spanish origin
Indigenous, Native American, or Alaska Native
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White or European American
A racial or ethnic identity not listed above
Highest Level of Education
High school diploma/GED
Trade, technical, or vocational training
Some college credit, no degree
Associate degree (e.g., AA, AS)
Bachelor’s degree (e.g., BA, BS)
Master’s degree (e.g., MA, MS, MEd)
Doctorate or professional degree (e.g., PhD, EdD, MD, JD)
Tell us a little about yourself. Please share anything you’d like us to know, such as your family, education, work, interests, hobbies, or a fun fact.
Have you ever participated in community organizing or activism? If yes, please briefly describe the activity or experience.
If you have not had time to be actively involved in any community organizing or activism, what has changed that now enables you to seek involvement in creating community change?
Residency
Caledonia
City of Racine
Kenosha
Mount Pleasant
Sturtevant
Union Grove
Waterford
Wind Point
Length of residency or employment in Racine/Kenosha area?
What personal strengths or experience(s) would you bring to the Builders program?
How do you expect the community to benefit from your successful completion of the program?
What community challenge are you most interested in developing the skills and practice of being a builder of social justice? Check up to 3 areas.
Children & Youth
Community Health, Equity & Safety
Culture and the Arts
Education
Employment & Economic Opportunity
Governance & Civic Engagement
Image of the greater Racine area
What do you hope to gain if selected to participate in the Builders program?
Continue
5
Donate
Please enter your donation amounts below
$
Operational Donation
Please select an amount if you would like to make an additional donation to support operational expenses for the retreat ministry.
$
Scholarship Fund Donation
Please select an amount if you would like to make an additional donation to support the scholarship program.
Continue
6
Security Check
Security check
Continue
Apply Now