OCJI Fellowship Application

Personal Information

Name

First NameMiddle NameLast Name

Birthdate

Date

Birthplace

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Email

Parents Information

Father's Name

First NameLast Name

Father's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mother's Name

First NameLast Name

Mother's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Guardian's Name

First NameLast Name

Guardian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

School Information

Major Of Choice

Student Number

Class Year

Cumulative GPA

Narrative Portion

The O.C. Justice Initiative emphasizes BIPOC youth leadership. How do you envision empowering young people of color to become effective advocates for social change in Orange County*

Why do we ask? We will use your answer to help understand what position we will offer you.

How would you address individualism within the fight for liberation for BIPOC communities?*

Why do we ask? We practice collectivism at our organization so we would want our members of our team to understand unity is at the center of all our work.

What idea would you add to our new anti-hate campaign at Chapman University that addresses the root causes of discrimination while promoting healing and solidarity across diverse communities? Please just provide a example of how you would educate on preventing hate on campus*

Why do we ask? We will use this answer to determine your interest in long term community organizing.

What’s at stake in your community and what do you hope to achieve to address it? Tell us about progress you’ve made, what remains in the way and how our scholarship would help?*

Why do we ask? We believe social justice will be achieved through base-building, and grassroots organizing movements that seek to transform power and change unjust systems.

Are you/were you a member of any organization?*

We would like you to list the names of organizations, networks, coalitions and alliances with whom you partner and collaborate in a meaningful way -- local, state, regional, and national -- and describe the nature of your partnerships.

Have you received any scholastic achievement awards?*

Why do we ask? So we can understand who you are, and what you are capable of.

Personal References

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

DISCLOSURE, WAIVER, AND AFFIRMATION

By Submitting this form, I affirm to have read and understood the terms and conditions of the Scholarship. I affrim to do the duties to the best of my abilities.

I give permission to my school to disclose any information, including, but not limited to, my transcript of my records and other necessary information requested by the Institution for consideration to be part of the scholarship program.

I understand that the information disclosed herein this application shall only be accessible only to authorized persons who shall review this application.

I affirm that the information provided herein are true and correct to the best of my knowledge. Any false representation to any of the information I have disclosed may be used against me and may cause my disqualification to the program.

Signature of Applicant

Date Signed

Date

O.C Justice Initiative Fellowship Application