Participant Eligibility Form

The Emerging Leaders Fellowship is an 8-week, Black-focused program. Over the 8 weeks, you'll take part in:

  • 20 hours per week of one-on-one coaching, virtual group sessions, and specialist support
  • A hands-on placement matched to your goals and interests
  • Skills development built around how you work best
  • Jobs and career pathways: employer connections and support planning your next steps
  • Black disability confidence and self-advocacy: knowing your needs, and knowing how to ask

To register and confirm your eligibility, please complete the form below.

We are requesting this information to determine eligibility for the Emerging Leaders Fellowship and to support program planning. Your responses will be used strictly for intake, accessibility, and reporting purposes, and will only be reviewed by the Ase team.

Fields marked with * are required.
CONSENT

Before you start, we need your permission to collect and use the information in this form.

Question Title

1. I consent to Ase Community Foundation collecting and using the information provided in this form to determine my eligibility, connect me to appropriate programs/services, provide support and meet program evaluation/reporting requirements in accordance with Ase's privacy practices. (Required.)

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