Brave Space Application Form

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Your Name(Required)

First Last Phone or Cell

Say A Bit More!(Required)

Your Racial Identity Your Preferred Pronoun Your Gender Identity

Where do you live?(Required)

City State Country

Tell us why you are interested in participating to Brave Space and how you hope it will support your leadership?(Required)

In a sentence or two, share why you said YES! to Brave Space.

You must complete Mindful of Race 101 prior to application approval.

Include below the date you completed Mindful of Race 101 or the date you are scheduled to take Mindful of Race 101:(Required)

Are you attending Brave Space with other affinity group members? If so, include their names here:

Acknowledges

By checking this box, you acknowledge and agree to the Policies & Practices stated in this program.

By checking this box, you agree to complete Mindful of Race 101 prior to attending Brave Space.

Feel free to email [email protected] with any questions you have.