Thank you for taking the time to complete this brief application. We are VERY excited you are interested in learning skills to be a community leader and advocate and would like to learn a little more about you.

Please take 7 minutes to complete this survey. 

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* 1. Why are you interested in being a community leader in this cohort?

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* 2. What communities are you part of? And/or what life experiences do you have? Please check as many boxes as apply to you.

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* 3. What community issues are important to you?

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* 4. What is your monthly income? (Used for demographics for grant purposes)

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* 5. How many people are in your household?

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* 6. Do you need childcare for meetings? 

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* 7. Do you need interpretation?

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* 8. How old are you?

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* 9. Please give us your contact information so we may call you for next steps.

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