Application Form
Please note that participation in the program requires that you register as an affinity group with at least four and no more than eight members. We strongly advise groups of nine or more to break into smaller cohorts and fill out a separate application. 

Please review and discuss the FAQsIf you have questions prior to applying, contact support@ruthking.net.

Note: Participant emails listed below will be used for log-in purposes.

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Email *
Name of the Designated Coordinator  *
First and last name
Email of Designated Coordinator *
First and last name
Name of your company or organization, if applicable
How many people are in your racial affinity group? *
Required
Please select the racial identity that most nearly represent your groups' affinity:  *
What are the gender identities of your affinity group members? *
Group Member #1 (Name) *
First and last name
Group Member #1 (Email address) *
Group Member #2 (Name) *
First and last name
Group Member #2 (Email address) *
Group Member #3 (Name) *
First and last name
Group Member #3 (Email address) *
Group Member #4 (Name) *
First and last name
Group Member #4 (Email address) *
Group Member #5 (Name)
First and last name
Group Member #5 (Email address)
Group Member #6 (Name)
First and last name
Group Member #6 (Email address)
Group Member #7 (Name)
First and last name
Group Member #7 (Email address)
Group Member #8 (Name)
First and last name
Group Member #8 (Email address)
At this time, partial and limited scholarships are available to BIPOC participants if needed. 

If any of your racial affinity group members are requesting BIPOC scholarship support, please list their names here: 

*
How will your group meet each month? Note: It will be up to your group to arrange meeting logistics. *
What city, state, and/or country does your group members represent? *
Acknowledges *
Required
Share your group's motivation and intention for signing up for Brave Space! *
Welcome! I can't wait to support your journey. See you soon, Ruth King 
A copy of your responses will be emailed to the address you provided.
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