Page 1
Program Participant
Contact
Contact Information
First Name
Last Name
Email
Mobile Phone
Home Address
Street Address
City
State
Please select...
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip/Postal Code
Social Media
LinkedIn Profile
Please paste the profile URL.
Facebook Profile
Please paste the profile URL.
X (Twitter)
Profile
Please paste the profile URL.
Any other related website or social media
Demographics
Gender
Please select...
Male
Female
Non-binary or third gender
Other
Prefer not to say
New Politics does not discriminate on the basis of gender identity or expression.
Gender: If you selected Other, we invite you to self-identify
Race, Ethnicity, or Origin
Asian
Black or African-American
Hispanic or Latina/o/x
Native American or American Indian
North African or Middle Eastern
Pacific Islander
White
Prefer not to say
Other
Please select all that apply. New Politics Leadership Academy does not discriminate on the basis of race or ethnicity.
Race: If you selected Other, we invite you to self-identify
How did you hear about New Politics Academy?
Please select...
Attended an Event and Spoke to an NPLA Representative
Friend or Colleague
Higher Education Institution
I'm a State Teacher of the Year or Finalist
Job Board
Military Veteran Organization
National Service Alumni Network
New Politics Leadership Academy Alumni
Other
Service Professional Organization
Social Media
Web Search
If you were referred to this program by an alum, who referred you?
Please select the Organization who referred you.
Please select...
Georgia STANDUP
Atlanta Black Chamber
The Mission Continues
Amigos de la Comunidad
Advancing Justice - Atlanta
On-Ramps Communication
Other
If other, please enter the Organization who referred you.
Source - Other
Current Occupation
What is the nature of your service experience?
AmeriCorps
AmeriCorps City Year
AmeriCorps JusticeCorps
AmeriCorps NCCC
AmeriCorps Public Allies
AmeriCorps Teach for America
AmeriCorps VISTA
AmeriCorps Youthbuild
Foreign Service Officer
Healthcare Professional
Intelligence Community
Jesuit Volunteer Corps
No military or national service experience
Nonpartisan Employee of a local, state, or federal government office
Nonprofit Staff
Other
Peace Corps
Social Worker
State Teacher of the Year or Finalist
Teacher in K-12 or Nonprofit Sector
U.S. Air Force
U.S. Army
U.S. Coast Guard
U.S. Marine Corps
U.S. National Guard
U.S. Navy
U.S. Space Force
Please describe your service experience in 25 words or less.
For example, Teacher, Social Worker, Military Spouse
Why are you interested in becoming an Answering the Call facilitator?
Please briefly describe your experience facilitating small group learning experiences.
Please briefly explain how you understand the work of facilitation.
Please tell us about your willingness and ability to manage the administrative dimension of this role.
Are you willing to facilitate a virtual group?
Yes
No
Anything else you'd like us to know?
By submitting this form, you're consenting to being contacted by New Politics Academy. We'll never spam you and we respect your privacy.