2026-2027 Collective Access Program Application

Collective Access Program

By joining the Collective Access Program, your team will be seamlessly integrated into a network of support and innovation, fostering growth and unity in our shared mission. Please provide the information requested below. If you have any questions please email Shaquita Chapman at membership@blackdefender.org
Organization *
Contact Name*

First NameLast Name
Title:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Work Number
Format: (000) 000-0000.
Website
Budget Information
Total Annual Budget *
Funding Sources *
Office Data

Please indicate the number of staff at your organization (all offices) in the categories below:
Staff *
Attorneys*
Office Information
Public DefenderStatewideCountyFederalCityLocalAppellateOther
Office Participation & Outreach
Who will be the primary point of contact for the Collective Access Program during the 2026-2027 year, and what is their contact information?*
Community Engagement FellowshipLaw School Summer FellowshipBothNo
If your office is interested in hosting a fellow, please provide the name and email address of the main contact person.
Are there any training topics you would like BPDA to cover or address during the 2026-2027 year?*
If applicable, please provide the name and email address of your Training Director.
YesNo
Please provide your office’s social media handles or any relevant social media information
Sign & Payment Information
Chief Defender/Director or CAP Point of Contact*
Date of Signature*

MonthDayYear
Date
Payment Method

Make all checks payable to NLADA with BPDA in parenthesis.

1901 Pennsylvania Ave NW, Suite
500 Washington, DC 20006
Phone 202.452.0620

BPDA is a section of NLADA. Payment is due within 30 days. If you
have any questions concerning this invoice, contact Alaina Bloodworth at
a.bloodworth@blackdefender.org.
Please verify that you are human*
Should be Empty:

Collective Access Program

Budget Information

Office Data

Office Information

Office Participation & Outreach

Sign & Payment Information

Payment Method