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Segal Program Interest Form
Thank you for your interest in the Segal Program!
Please take a moment to fill out this form for further information and/or stay connected.
Visit us online:
heller.brandeis.edu/segal
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Email
*
Your email
First & Last Name
*
Your answer
I am a ...
*
Brandeis undergraduate student
Heller MPP candidate
Faculty/Staff
Other:
What is your graduation year?
*
Your answer
How did you hear about us and/or or event(s)?
*
Segal flyer
Segal website
Referred by staff/faculty (share name in Other)
Segal social media (share platform in Other)
Segal Fellow/Staff (share name in Other)
All-Heller email promotion
Other promotion (share in Other)
Other:
Which event did you attend?
*
Internship/All Majors Fair (10/9)
Hiatt Info Session (10/17)
1st Year MPP Town Hall (10/22)
Submitting this form, did not attend an event
What are your areas of interest?
*
Arts
Child/Family Welfare
Community Organizing/Advocacy
Community/Urban Development
DEI/Racial Justice
Disability
Disaster Response
Economic Development
Education/Youth Development
Entrepreneurship/Business
Environmental/Climate
Gender/Women's Issues
Gun Control
Health
Housing/Gentrification
Immigration
International
Labor/Work Issues
LGBTQ+
Law/Criminal Justice
Politics
National Service/Civic Engagement
Philanthropy
Youth Empowerment
Required
Any additional information/questions you'd like to share?
Your answer
Send me a copy of my responses.
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