VAPLP Pod 12 Application Form

VAPLP Pod 12 Application Form

Application due Friday, March 13, 2026. For the free-response section of this application, we do not permit AI-generated responses. If AI use is detected in the application, it will automatically be forfeited. To ensure everybody has the opportunity to put their best self forward, we welcome responses to be submitted in written, visual, audio, or video form. If you have any questions, please email vaplp@engageva.org

Personal and Contact Information
Name*

First NameLast Name
Chosen Name
If different from name above
Pronouns*
Ex. she/her, he/they, they/them etc
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Stipend Self-Assessment
Please reflect on the following questions and designate your eligibility level below.

We offer accessibility stipends, such as travel stipends, and utilize sliding scale tiers that correspond to individual access to money and wealth. Our sliding scale is an intentional effort to distribute resources equitably, with credit to the Anti-Oppression Resource & Training Alliance.
1. Are you and your family homeowners or landowners?

2. Are your bills or credit cards on autopay?

3. Have you not had difficulty accessing and affording healthcare or health insurance for you or your family members?

4. Do you have zero to no debt and/or do you have disposable income?

5. Do you have a safety net composed of “financially stable” or wealthy family and friends?

6. Do you have U.S. Citizenship?

7. Does your income only support you, and not other loved ones?

8. Have you or do you expect to inherit money or property?

9. Have you (or could you have) attended college?

10. Have you (or could you have) attended graduate school?

Eligibility Level Determination

If you answered “no” to more than five questions → Full Stipend Eligibility

If you answered “yes” to five or more questions → No Stipend Eligibility
Based on your answers to the self-assessment, please select your eligibility level.*

Full Stipend EligibilityNo Stipend Eligibility

Accessibility
All participants will receive a travel stipend pending self-assessment.
Would any of the following services allow you to participate in the program fully and comfortably?

Spanish-English language interpretationChildcare stipendWheelchair accessQuiet area/sLow/Dim lighting area/sChemical/fragrance free space/s
If you selected "childcare stipend," please note for how many children and what age.
If you have an access need not listed in the previous questions, please list it here.

Free Response Application Questions
Please answer the following free response questions in full (500 words or less).

We highly suggest you write these first in a separate document, save them, and then copy and paste them into the fields below. If you'd rather share your responses via audio, video, or visual forms, you are more than welcome to do so. If you choose video or audio, please keep your responses to less than two minutes. Most of all, please respond in the way that best allows you to show up fully. (Online voice recorder: https://www.rev.com/onlinevoicerecorder)
1. Please share a window into your personal story. Some examples of potential topics are:

-The people who have impacted your journey

-The experiences and environments that have shaped your life

-The ways you spend your time

-The things that motivate you personally or professionally

-Why you are excited to apply for VAPLP
If uploading a file- please indicate that here.
1. File Upload

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2. Each learning retreat has its own area of focus bound by a thread that connects them together. Tied, each participant adds their own unique gifts and experiences to our community. What are you looking to take away from the learning retreats? And what do you hope to bring to the pod?*
If uploading a file- please indicate that here.
2. File Upload

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Social Change Ecosystem Map
3. We anchor in Deepa Iyer’s Social Change Ecosystem Map. Take a peek at the ecosystem with the link above. What two to three roles describe you best and why? How do those roles connect to the community work you’re doing now or aspirationally? *
If uploading a file- please indicate that here.
3. File Upload

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4. With the current systemic, organized onslaught of attacks on trans youth and bodily autonomy, and as an organization based in Richmond, the former capital of the Confederacy, and in Virginia, one of the first sites of colonization and slavery in the US, we are especially committed to and responsible for combatting all forms of oppression, white supremacy, and injustice. In your personal and professional life, how do you move forward equity & social justice?*
If uploading a file- please indicate that here.
4. File Upload

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Attendance and Health & Safety Policy
By signing below, I confirm that I can be in full attendance of all four retreats (dates listed below). Acceptance into the program hinges on commitment to attending the entirety of all four retreats (save unpredicatble circumstances and emergencies). I confirm that I can commit to all the retreat dates below (Friday 12pm - Sunday 4pm).

Retreat 1: May 15-17 Middleburg, VA

Retreat 2: June 12-14 Washington, DC

Retreat 3: July 17-19 Harrisonburg, VA

Retreat 4: August 14-16 Richmond, VA

We require VAPLP participants to be vaccinated unless there are medical or religious considerations. By signing below, I agree to this protocol.
Signature*

Clear
What is your t-shirt size? Sizes/t-shirts are unisex.*
How did you hear about VAPLP? This does not affect your candidacy and is only used for recruitment evaluation purposes.*

Interest FormNominationVAPLP AlumVCET Table PartnerInfo SessionFacebookInstagramOther
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VAPLP Pod 12 Application Form

Please reflect on the following questions and designate your eligibility level below.

All participants will receive a travel stipend pending self-assessment.

We center Black and Indigenous folks, people of the global majority, and folks with diverse lived experiences.

Please answer the following free response questions in full (500 words or less).