Equity by Design Immersive Scholarship Application

Thank you for your interest in the Equity by Design Immersive Series. We're grateful to have the opportunity to provide scholarships to facilitate more equitable access to this weekend-long engagement. Applications will be considered on a rolling basis and will be reviewed regularly until either the allotted amount is awarded.

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* First + Last Name

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* Pronouns (e.g. They/them, she/her, he/him, etc.)

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* Which age range below includes your age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* Please self-identify your race/ethnicity

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* Contact information

Street Address *

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address

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* Employer/Organization/School

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* Sector(s) in Which You Work

Health (healthcare, public health, etc)

Media (includes journalism, design, advertising, technology, etc)

Government/Public Service/Non-Profit

Education

Other (please specify)

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* Please share your interest in participating in the Equity by Design Immersive Series. What are your hopes for the weekend and how do you see this experience being applied to your life and/or work? (100 words or less)

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* Are you applying for a full or partial scholarship?

Full

Partial

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* Please select the Equity by Design Immersive for which you are applying

Baltimore (April 24-26)

Chicago (June 5-7)

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* What makes you a good candidate for this scholarship opportunity? (100 words or less)

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* Please share about your identity (providing as much or little as feels important or helpful for you to share - might include age, ability status, ethnicity, gender identity, etc.).

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* Please reflect on and share about the role of power in your life, and what power shifting/sharing might look like. (100 words or less)

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* Please select one Narrative & Livelihood Shaper (Health/Healthcare, Media, Education, or Government/Public Service) and share about the influence it has had on your personal narrative. (200 words or less)