CLA Class Application: Part 1

Thank you for applying to Civic Leadership Academy! The application has three parts, all of which need to be submitted by June 16th at 12pm. You're at Part 1, where you'll let us know your contact information and how you heard about Civic Leadership Academy, as well as some information about yourself. When you hit submit, we'll send you a link to Part 2 of the application.

If you have any questions, email cla@cohesionnetwork.org.

Full Name* This field is required.

First Name

Last Name

Phone Number* This field is required.

Area Code

Phone Number

E-mail (please use personal email, not work email)* This field is required.

How did you hear about us? Check all that apply.* This field is required.

Word of Mouth

Friend/Colleague

Social Media Ad

Facebook

Instagram

Online Publication- article, blog post, etc.

Newsletter- Cohesion Network

Newsletter- Other Organization

Civic Leadership Academy Information Session

Presentation

None of the Above

Other

From which friend/colleague did you hear about us?* This field is required.Please include first and last name.

From whose Facebook did you hear about us?* This field is required.Please include first and last name.

From whose Instagram did you hear about us?* This field is required.Please include first and last name.

From whose LinkedIn did you hear about us?* This field is required.Please include first and last name.

From what organization's newsletter did you find out about us?* This field is required.

From what organization's email did you hear about us?* This field is required.

At what organization's presentation did you hear about us?* This field is required.

Would you like to receive the Civic Leadership Academy newsletter?* This field is required.

Yes

I already receive it

At Civic Leadership Academy, we are intentional about recruiting a class that reflects the diversity of our community. While the following questions are optional, they will help us understand who is applying to Civic Leadership Academy. Please know that these questions do not have any bearing on whether or not you are selected for Civic Leadership Academy, and your individual answers will remain confidential.

Please use the option to write in how you identify by clicking on "prefer to self-describe" and typing your answer there, and you are always welcome to choose the “prefer not to answer” option.

We know the most successful movements are intergenerational. Therefore, we would appreciate you sharing when you were born.

Date

56% of Allentown Residents speak a language other than English at home. What languages do you speak or understand?(Select all that apply and indicate your level of proficiency)

Spanish

Arabic

Other

Language proficiency

I understand some

I can have basic conversations

I am comfortable speaking

I am fluent

I prefer to communicate in this language

Please select or describe your gender identity/identities (choose all that apply)

Woman

Man

Non-binary/gender diverse

Prefer not to answer

Other

Which of the following best describes your sexual orientation? (Optional)

Straight/ heterosexual

Gay or lesbian

Bisexual

Queer

Prefer not to answer

Other

How do you describe your race and/or ethnicity? (Select all that apply)Choose the option(s) that best fit you. You’re welcome to describe it in your own words if you prefer.

American Indian or Alaska Native

Black or African American

Central Asian

East Asian

Hispanic or Latino/a/e

Middle Eastern

Native Hawaiian or other Pacific Islander

North African

South Asian

Southeast Asian

White

A race/ethnicity not listed here

Prefer not to answer

Other

Select the option(s) that best describe your religious affiliation:

Agnostic

Atheist

Baha’i

Baptist

Buddhist

Catholic

Church of Christ

Episcopalian

Hindu

Jehovah’s Witness

Jewish

Lutheran

Methodist

Mormon

Muslim

Non-denominational Christian

Orthodox, such as Greek or Russian Orthodox

Pagan

Pentecostal

Presbyterian

Protestant

Reformed, Christian

Sikh

Unitarian

Spiritual but not religious

Nothing in particular

Prefer not to answer

Other

Were you raised in the Allentown area?

Yes

Where do you currently live?

Allentown (within city limits)

Lehigh Valley (outside Allentown)

Other

What Allentown neighborhood do you live in?

Center City

South Side

East Side

West End

Other

What is your connection to Allentown’s children and/or school systems? (Select all that apply)

I am a parent or caregiver of school-aged children

My children attend or attended Allentown School District schools

My children attend or attended non-Allentown School District schools

I work in a school or youth-serving organization

I volunteer or engage with youth in the community

I do not have a direct connection, but care about outcomes for Allentown’s children

Other

Have you or your parents ever experienced moving to a new country? Your response is confidential and will only be used to help us understand the experiences represented in our cohort.

Yes, I and/or my parents immigrated to the United States

Yes, I and/or my parents moved to a country other than the United States (e.g., as the child of missionaries; or as the child of military parents)

64% percent of residents in Allentown are considered economically disadvantaged. Do you have experience with what it means to be economically disadvantaged? *Choose all that apply

Yes, I have experienced being economically disadvantaged

Yes, people close to me (e.g., friends, family) have been economically disadvantaged

Yes, I have worked or volunteered extensively with community members who are economically disadvantaged

Yes, I have lived in a neighborhood or community where many people are economically disadvantaged

Other

Do you have a disability as defined by the Americans with Disabilities Act?

Yes

That's it for Part 1 of the application! When you press submit, you will receive an email with the link to Part 2. For tips on completing Part 2, check out the Apply Now page of our website: https://www.cohesionnetwork.org/cla-apply

Remember, you should send out Part 3 of the application, the Reference Form link, as soon as possible so that it is completed by your references by June 16. Copy this link and send it to two references: https://forms.gle/FumFmMfg6VAWnopUA. The reference form can be completed in English or Spanish.

If you have any questions, email us at: cla@cohesionnetwork.org