Interested in joining the BIPOC Women Leaders Coaching Program? Start here.
Filling out this form will help us understand more about you in order to better craft experiences to support you and this community overall. *We ask White individuals who are allies to preserve this space for the BIPOC community.*
Click the button below to start.
Question 1 of 14
First Name
Question 2 of 14
Last Name
Question 3 of 14
Preferred Name to go by:
Question 4 of 14
How did you hear about the BIPOC Women Leaders Coaching Program?
Question 5 of 14
Your Email (the email you will use to sign-up for the BIPOC Women Leaders Coaching Program):
Question 6 of 14
Race (choose all that apply):
American Indian, Alaskan Native
Asian
Black, African-American
Latine/Hispanic
Multiracial
Native Hawaiian, Pacific Islander
White
Other (please answer below if other)
Question 7 of 14
If you answered Other in the previous question, please answer here. If this doesn't apply to you, put N/A.
Question 8 of 14
Pronouns (I.e. she/her/hers, he/him/his, they/them/theirs, etc.): https://www.mypronouns.org/what-and-why
Question 9 of 14
Gender Identity:
Cisgender female
Cisgender male
Gender non-binary
Gender fluid
Genderqueer
Transgender
Trans woman
Trans man
Question 10 of 14
Question 11 of 14
Are there any accommodations you will need to participate in this program, that we should be aware of?
Question 12 of 14
Why are you interested in the BIPOC Women Leaders Coaching Program? Please share 3-4 sentences.
Question 13 of 14
Do you have a promo code? If not, enter N/A.
Question 14 of 14
Any other questions or comments? If this doesn't apply to you, put N/A.