Leadership for Social Change Application Form

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Thank you for your interest in Groundswell’s Leadership for Social Change course! We’re interested in getting to know you better so we’ve got a few questions for you. There’s also some space in this form for you to ask us any questions.

A few things to remember as you fill this out:

1. We are not looking at grammar, spelling, or sentence structures as a qualifying factor. You're probably pretty awesome and we want to hear about you and what you care about.

2. The information you share with us will be strictly confidential and only looked at by Groundswell staff for the purpose of admission.

3. This application form does not guarantee you a spot in the course. We we will review applications and begin scheduling phone interviews (very casual) on April 22.

4. If you need support in filling out this application form, please email programs@groundswellschool.com and the Groundswell staff can offer assistance.

5. The deadline for this application is April 29th, 2024.

Email *

Full Name *

Pronouns (e.g. she/her, he/him, they/them, other or self-describe) We'd like to know how to refer to you!

Email Address *

Phone Number

What language(s) do you know/use?

This offering of Leadership for Social Change is for folks that identify as women, trans, non-binary, or gender non-conforming. Please share with us the parts of your identity you feel comfortable disclosing. (Optional)

Are there other parts of your identity that you would like to share with us? (Optional)

Do you have any accessibility needs that you would like to share with us?

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