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DELL 2023 Interest Form
Please take 3-4 minutes to answer the following questions.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
I would like to attend the Digital Equity Leadership Lab
*
Yes
No
What is your age range?
*
18-24
25-34
35-44
45-54
55 or older
What pronouns do you use? (Check all that apply)
*
She / Her
He / Him
They / Them
Other:
Required
What is your race or ethnicity? (Check all that apply)
*
White
Black
Latinx
Asian
Indigenous
Other:
Required
What Baltimore City neighborhood do you live in?
*
Your answer
Organization/ Affiliation
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Your answer
Why are you interested in participating in the Digital Equity Leadership Lab (DELL)?
*
Your answer
Please share a short bio about yourself. (150 words total, or it will be edited for length)
*
Your answer
Do you have any questions regarding your participation in DELL? (Optional)
Your answer
Thank you for submitting your Interest Form.
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