Civic Mission Fellows Program Application

Civic Mission Fellows Program Application

Please complete the form to apply for the Civic Mission Fellows Program.
Section I. Applicant Information
Full Name

First NameLast Name
Current Title/Role
Institution
Department/Division
Institution Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Years in Higher Education Leadership

5 - 1011 - 1516+
Section II: Institutional Context
Institutional Context

Public UniversityPrivate UniversityCommunity CollegeLiberal Arts CollegeOther
Briefly describe your institution's current approach to civic learning and engagement (200-300 words).
Section III. Leadership Role and Readiness
The Civic Mission Fellows Program is designed for senior leaders in higher education.

Please indicate the role that best describes your involvement in implementing your institution’s civic mission. Applicants must select one primary role.
- Primary Lead
  I have been formally tasked with primary responsibility for overseeing and implementing my institution’s civic mission. My role includes setting strategic direction, coordinating across units, and ensuring institutional alignment and accountability for civic learning and engagement initiatives.
- Collaborative Lead
  I am a key member of a designated leadership team, committee, or working group responsible for executing my institution’s civic mission. I contribute to strategy development, implementation, and cross-unit collaboration, though ultimate authority is shared among multiple leaders.
- Individual Advocate
  I actively advance my institution’s civic mission through my professional work (e.g., teaching, research, programming, or partnership development), though I do not currently hold a formal administrative or leadership role in institution-wide implementation.
Please select your primary role.

Primary LeadCollaborative LeadIndividual Advocate
Section IV. Commitment and Participation.

Are you able to fully participate in the following program components?

	Yes	No
10-day residential retreat in Augsburg, Germany (December 4-13, 2026)
Quarterly two-day in-person workshops
Monthly virtual mentoring sessions

If you have any limitations, please explain here:
Section V. Institutional Support
Has your institution committed to supporting your participation, including travel-related expenses and the $3,000 program fee?

YesPendingNo
Section VI. Attachments
Please upload the following as PDFs:
- Current CV or résumé
- Statement of institutional support (if available)
- Optioanl supplemental materials (e.g., strategic plans, civic initiatives)
Cancelof
Section VII. Certification
I certify that the information provided in this application is accurate and that I am able to commit to full participation in the Civic Mission Fellows program.
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Civic Mission Fellows Program Application

Section I. Applicant Information

Section II: Institutional Context

Section III. Leadership Role and Readiness

Section IV. Commitment and Participation.

Section V. Institutional Support

Section VI. Attachments

Section VII. Certification