Winter 2022 Accelerator Program Application Form

First Name *

Applicant First Name

Last Name *

Applicant Last Name

Title *

Organization *

Email *

City *

State *

State or Province

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Country *

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Briefly describe why you are interested in the DEI accelerator program. *

What impact will your participation in the Accelerator program have on your company? *

What do you hope to be able to do at your company/organization after completing the Accelerator Program?

What do you hope to learn and/or accomplish through this program? *

Please share any personal or professional goals you have with respect to the Accelerator Program.

Optional: Share your diversity story.

Does your employer support your participation in the CADIA DEI Accelerator Program? *

Yes or No with comment if needed.

Accommodations

Do you require any accommodation for the Accelerator Program and/or is there anything that you would like to share with the organizers in advance that might help them make your experience more beneficial?

Upload a Recommendation Letter (.pdf) *

This recommendation may be from a supervisor, colleague, or professional or personal contact  The letter need not be long but should include an endorsement of the candidate.

20MB max