ECS MindSet Application

Welcome to MindSet! Please answer the following questions so we can learn a little more about your interests and goals.

MindSet does not discriminate on the basis of age, race, ethnicity, gender, sexual orientation, disability, or religion. All responses will be kept confidential.

NOTE: The MindSet application takes approximately 45 minutes to complete and is recommended that you complete on a desktop computer or tablet NOT on a mobile phone. You will be asked to upload a resume and writing sample and include a list of references. You DO NOT have the ability to stop and start the application or save the application throughout so it is recommended that you allow 45 to 60 minutes to complete the application and have gathered all of the listed materials.

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* 1. First Name

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* 2. Last Name

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* 3. Address

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* 4. Birthdate (ex. 01/01/2000)

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* 5. Cell Phone Number

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* 6. Home Phone Number

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* 7. Email Address

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* 8. Have you completed any training or certification programs?

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* 9. Gender

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* 10. Race

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* 11. Ethnicity

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* 12. Why do you want to be admitted to MindSet?

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* 13. How did you hear about MindSet?

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* 14. Please upload a copy of your resume

PDF, DOCX, DOC file types only.
Choose File

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* 15. Recommendations

Please provide the names and email addresses of two people who know you professionally or academically and can provide a recommendation for you. For example, a supervisor, co-worker, teacher, or mentor. 

We will email your references with a recommendation form for them to complete. Please let them know this form must be completed within 7 business days, and is estimated to take only six minutes or less to complete.  
Please note that your application will not be complete until we have received your recommendations. 

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* 16. Please check off the days that you would be available to engage in MindSet activities (workshops, presentations, guest speakers, etc.). Please note we do not offer MindSet activities 5pm-7pm on Fridays and Saturdays.

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* 17. Please check off the times that you would be available to engage in MindSet activities (workshops, presentations, guest speakers, etc.). Please note we do not offer MindSet activities 5pm-7pm on Fridays and Saturdays.

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* 18. Writing Prompt. Please type your response below in the form of 2 to 3 paragraph(s).

Imagine that five years from now you are delivering the keynote speech at an important event, What kind of event would you want to be invited to speak at? What information would you want the person introducing you to include in your bio? Some ideas you may consider could be:
  • Educational history, credentials, employment milestones that you will have achieved in the future
  • A list of your accomplishments
  • Key values that inform your work

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