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Black Defender Leadership Institute 2.0
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1.
First Name
(Required.)
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2.
Last Name
(Required.)
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3.
Pronouns
(Required.)
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4.
Are you a member of BPDA (membership is required to participate in BDLI 2.0)
(Required.)
Yes
No
I'm not sure
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5.
Preferred email
(Required.)
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6.
Mailing address
(Required.)
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7.
What is your race?
(Required.)
Asian
Black or African American
Middle Eastern or North African
Hispanic or Latino
Multiracial or Multiethnic
Native American or Alaskan Native
White
Native Hawaiian or other Pacific Islander
Another race or ethnicity, please describe below
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8.
What is your organization's name?
(Required.)
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9.
Who is your Executive Director
(Required.)
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10.
What is our title in your organization?
(Required.)
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11.
Does your organization serve an indigent/marginalized population(s)
(Required.)
Yes
No
I'm not sure
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12.
Does your office provide any training related to race and/or bias?
(Required.)
Yes
No
I'm not sure
13.
If yes, please describe.
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14.
How many people work at your organization?
(Required.)
0-10
11-20
21-30
more than 30
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15.
How many BIPOC hold leadership position(s) at your office?
(Required.)
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16.
Have you ever applied for a leadership position within your office?
(Required.)
Yes
No
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17.
If accepted in BDLI 2.0 what is the leadership goal/project that you want to work on during your time in the institute. 500 word limit
(Required.)
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18.
How is your leadership goal/project related to the six core competencies of transformational leadership?
(Required.)
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19.
Are you open to receiving feedback from your trainers and/or cohort concerning your leadership goal/project?
(Required.)
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20.
What challenges do you anticipate in accomplishing your leadership goal project?
(Required.)
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21.
What specifically do you hope to learn or gain by participating in BDLI 2.0?
(Required.)
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22.
In BDLI 2.0, each participant will be partnered with a mentor to help with your leadership goal/project. What do you need from your mentor to accomplish your leadership goal?
(Required.)
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23.
Do you know of someone who you believe can mentor and help you achieve your Leadership Goal/Project?
(Required.)
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24.
Are you able to fully commit to all the participation requirements which include 10 hours a month?
(Required.)
Yes
No
I'm not sure
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25.
How will you make time in your schedule to fully participate in programming?
(Required.)
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26.
If accepted in BLDI 2.0, do you believe your office will support your participation? If so, how?
(Required.)
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27.
Please submit a headshot
(Required.)
Choose File
No file chosen
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28.
Please submit a one paragraph bio
(Required.)
Choose File
No file chosen
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29.
Please submit your resume
(Required.)
Choose File
No file chosen
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30.
How did you hear about BDLI 2.0
(Required.)
Facebook
Twitter
LinedIn
BPDA website
Word of mouth
Other (please specify)
31.
Thank you for applying to the BDLI 1.0. We are excited to review your application. If you have any questions please feel free to contact us at <info@blackdefender.org>