Emerging Leaders Program Application
Deadline for Applications: September 1, 2022
Name
*
First Name
Last Name
What Pronouns do you use?
Organization
Job Title
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Why are you interested in attending the Emerging Leaders Institute?
*
What leadership challenges have you encountered as a leader?
*
What are your goals as you think about being a leader in community media?
*
Check all the racial/ethnic categories that apply to you.
Black/African American
Hispanic/Latino/Chicano/Latinx
Asian/South East Asian/Pacific Islanders
Native American/ Alaska Native Indigenous
White / European
Other
Decline to State
Which communities have you worked most closely with in the past three years.
Majority White
Majority Black
Majority Spanish speaking
Majority immigrant
Majority indigenous
LGBTQ
Other
Submit
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