BreakFree Fellowship Application For Host Organizations

BreakFree Fellowship Application For Host Organizations

Please fill out the form below if you are interested in becoming a Host Organization. A member of the BreakFree Team will reach out to you after your application is reviewed.
Your Name *

First Name Last Name
Your Email *
example@example.com
Your Phone Number *
Please enter a valid phone number.
Organization's Name *
Why is your Organization interested in hiring a IRAA Fellow? *
What department or position does your Organization envision integrating your Fellow into preliminarily? *
What resources does your Organization have in place to support your Fellow’s successful transition into your Organization? *
Having a single, direct point of contact available to support your Fellow will be critical. Have you identified who this support person would be? *

Yes No Undecided/Would like to discuss with you.
What office productivity software does your Organization primarily use? *

Microsoft Windows Google Suite Other
Are you interested in hosting a Full-time or Part-time Fellow

Full-time Part-time (approximately 10 hours per week)
NOTE: BreakFree has funding to provide up to $15,000 per year for full-time fellows salary and to support stipends for part-time Fellows for a limited number of Host Organizations, if necessary.
For part-time: Are there certain times/days that you are looking for your Fellow to work? Are there certain responsibilities you'd like your Fellows to have?
Is your Organization committed to the salary range that is expected of Organizations participating in the Fellowship? ($45-55k annually for full-time, and $15-20/hour for part-time) *

Yes No Unsure
Are there any additional questions or concerns that you would like to address? If yes, please briefly list your questions in the box below; we will do our best to discuss them when we schedule a call with you. *
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