Social Justice Fellows Program, Application Form (Cohort IV)

Cohort IV Application Form

Thank you for your interest in The Memorial Foundation's Social Justice Fellows Program! The information collected in this application will be evaluated to determine your readiness to engage in the Foundation's Social Justice Fellows Program - Cohort IV, which will begin in January 2025. Please make sure you read the application fields carefully and complete each item in its entirety. Responses should be concise yet thoughtful with clear explanations and reasoning, not exceeding the word limit provided. While there is not a 'timed out' feature built into this form, we do encourage you to use the "SAVE" button at the bottom of the form to avoid potential loss of data. All applications and supporting materials are due by 11:59 p.m. ET on Friday, November 1, 2024. If you need any assistance in completing this form, please contact David Lewis at dlewis@thememorialfoundation.org.
SECTION I: TELL US ABOUT YOURSELF
First and Last Name*
Pronouns*
Email Address*
example@example.com
Phone*
Ethnicity*
Gender*
Birthdate*

MonthDayYear
Date
Street Address (# and Street Name)*
City*
State*
Zip*
Primary Area of Employment*
Highest Level of Educational Attainment*
How did you learn about the Fellows Program*
Why are you interested in the Fellows Program?*
Brief Bio max 250 word count*
SECTION II: TELL US ABOUT YOUR LEADERSHIP
In 500 words or less please tell us why this work is important to you and how your involvement in social justice and advocacy work have affected your life*

0/500
In 500 words or less, tell us about your leadership in advancing change in your community or workplace, and share one example that speaks to your experience in this area.*

0/500
In 500 words or less tell us what you hope to gain from this program and how it will assist you in achieving your advocacy goals What do you believe will change as a result of your participation*

0/500
SECTION III: REQUIRED ATTACHMENTS
Current Headshot*

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Leadership Resume (PDF ONLY)*

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Required Leadership Documentation*

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Optional Leadership Documentation

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Certification and Acknowledgment

By typing your full name below, you certify that you are the person you have represented in this application form. Additionally, you certify that the information you have provided is truthful and accurate. You acknowledge your understanding that providing false information will result in immediate dismissal from consideration (or termination from the Fellows Program if the discovery occurs after acceptance Your typed name below authorizes The Memorial Foundation and its representatives, as appropriate, access to review, inspect, and verify any information you have provided as part of your application for the Social Justice Fellows Program.
Full Name*
Date*

MonthDayYear
Date
Please preview and review your application carefully before pressing the submit button. You are NOT able to retrieve your application to make changes or edits once you submit it.
Should be Empty:

Cohort IV Application Form

SECTION III: REQUIRED ATTACHMENTS