Impact Factory Residency Application

1

Full Name* This field is required.

First Name

Last Name

2

Birthdate* This field is required.

Date

3

Grade/School Status* This field is required.

4

School Name

5

Email* This field is required.

example@example.com

6

Phone* This field is required.

Please enter a valid phone number.

7

Mailing Address* This field is required.

Street Address

Street Address Line 2

City

State

Zip Code

Country

8

How did you hear about us?* This field is required.

9

Parent / Guardian Name

First Name

Last Name

10

Parent / Guardian Email

example@example.com

11

Parent / Guardian Phone

Please enter a valid phone number.

12

Issue Area* This field is required.

What cause do you want to address?

13

Please describe the issue you want to address and why it matters.* This field is required.

14

What made you care about this issue?* This field is required.

15

Initiative Name* This field is required.

Come up with a name for your project. This can always be changed later."

16

Walk us through your idea and any first steps you’ve taken* This field is required.

17

Are you able to attend a monthly virtual meeting with your Mentor on the first Monday of each month, 5:00–6:00 PM CT* This field is required.This is a recurring commitment for the full year of your Residency."

Yes

No

18

Can you commit 2–4 hours per week to the Residency?* This field is required.

Yes

No

19

Do you have a team?* This field is required.

Yes

No

20

Team member 1 name

First Name

Middle Name

Last Name

21

Team member 1 contribution

22

Team member 2 name

First Name

Middle Name

Last Name

23

Team member 2 contribution

24

Team member 3 name

First Name

Middle Name

Last Name

25

Team member 3 contribution

26

Which support areas would you like from the residency?* This field is required.

Marketing & Communications

Finance & Legal

Nonprofit Basics

Working with a Mentor

Project Planning & Organization

Networking with other Residents

Other

27

If you selected "Something else," please describe