Welcome to the Fellows Program!

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Name*

First Last

What is your chosen name?*

If different from the previous.

What pronouns do you use?*

Here is more information about why we ask this question.

Phone*

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code

When is your birthday?*

Please a high quality photo of yourself for us to use to announce your cohort of Fellows on social media!*

Accepted file types: jpg, jpeg, png, gif.

Do you have the name of an emergency contact you can share with us?*

Phone number of emergency contact*

Email of emergency contact*

Would you be interested in carpooling for the retreat? Would you be willing to drive?*

We can help coordinate after we receive responses. Carpooling is preferred for parking.

Can we offer any specific living arrangements to ensure your experience at the Fellows retreat goes smoothly?*

For example, do you have any concerns about bunk beds, or sharing a room with someone else, each having separate beds?

Are there any accommodations we can provide to ensure the best possible learning experience for you?*

Examples include receiving class slides in advance, extra time for class activities, fidgets or other tools to help maintain focus, difficulty using stairs, etc.

What are some of your favorite snacks?*

What are your dietary restrictions or allergies? What is the severity?*

Example: Peanuts and I cannot be in the same room as them

What is your t-shirt size?*

2XL

3XL

What is your preferred method of communication?*

Text

Phone call

Other

Outside of evenings when typical meetings will take place, what days of the week and times do you have flexibility to meet if needed?*

For example, “Tuesday evenings and Saturday mornings.” We understand that schedules can change, we may use this information occasionally when there is a holiday, or if extra time is necessary to be scheduled.

Please link us to your Instagram account!*

If you have it. This is so we can tag you when we announce Fellows on social media.

Please link us to your Facebook account!*

If you have it. This is so we can tag you when we announce Fellows on social media.

Do you have any other forms of social media you’d like to share?*

Please connect with us if you have not already done so, and check off the boxes for each item you have completed!

Join our email list

Like us on Facebook

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