Private Application

"*" indicates required fields

Full Name*

First Last

What is your chosen name? If different from your full name above.

Pronouns

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Current Employer*

Current Occupation*

Which of the following best describes you & your work?*

Stipend Self-Assessment

with credit to Anti-Oppression Resource & Training Alliance

1. Are you and your family homeowners or landowners?

2. Are your bills or credit cards on autopay?

3. Have you not had difficulty accessing and affording healthcare or health insurance for you or your family members?

4. Do you have zero to no debt and/or do you have disposable income?

5. Do you have a safety net composed of “financially stable” or wealthy family and friends?

6. Do you have U.S. Citizenship?

7. Does your income only support you, and not other loved ones?

8. Have you or do you expect to inherit money or property?

9. Have you (or could you have) attended college?

10. Have you (or could you have) attended graduate school?

Compensation Level Determination

If you answered “no” to more than five questions → Full Stipend Eligibility

If you answered “yes” to five or more questions → No Stipend Eligibility

Based on your answers to the self-assessment, please select your compensation level.*

Full Stipend Eligibility

No Stipend Eligibility

Would any of the following services would allow you to participate in the program fully?

Spanish-English language interpretation

Wheelchair access

Quiet area/s

Low/Dim lighting area/s

Chemical/Fragrance free space/s

If you have an access need not listed in the previous questions, please list it here.

What's your t-shirt size?*

T-shirts are unisex.

How did you hear about VAPLP?

This does not affect your candidacy and is only used for recruitment evaluation purposes.

Interest Form

Nomination

VAPLP Alum

VCET Table Partner Communication

Info Session

Facebook

Instagram

Other

Demographics

We center Black and Indigenous folks, people of the global majority, and folks with diverse lived experiences.

How old are you?*

Please describe your race/ethnicity (check all that apply)*

Native or First Nation (e.g. Rappahannock Tribe / Monacan Indian Nation / Pamunkey Traditional Gov’t. / etc.)

Black / African / or African American (e.g. Jamaican / Nigerian / Haitian / Ethiopian etc.)

Hispanic or Latino/a/x/e (e.g. Puerto Rican / Mexican / Cuban / Salvadoran / Colombian etc.)

Asian Pacific Islander Desi American (e.g. Vietnamese / Indonesian / Pakistani / Sri Lankan / Native Hawai’ian etc.)

Southwest Asian or North African (e.g. Lebanese / Iranian / Egyptian / Moroccan / Palestinian etc.)

White or European (e.g. German / Irish / English / Italian / Polish / French etc.)

How would you describe your gender identity? (check all that apply)*

Woman

Man

Transgender

Nonbinary

Two-Spirit

How would you describe your sexual orientation? (check all that apply)*

Lesbian

Gay

Bisexual

Queer

Pansexual

Asexual

Straight or heterosexual

I am not sure

Prefer not to say

What is your primary language?*

Community Affiliations

Please select any VCET partners you're affiliated with.

Whether you're part of an organization as a member, employee, or volunteer, feel free to select as many that you're connected to.

Other Organizations/Associations/Unions

List any additional groups you are a member of

If you have participated in any other leadership development program(s), please list the name of the program and the year of completion.

What area does your work focus on? (check all that apply)*

We know much work gets done at the intersections of multiple issues, so please select as many as you closely work with.

Free-Response Questions

Please answer the following short essay questions in full (500 words or less). We highly suggest you write these first in a separate document, save them, and then copy and paste them into the fields below. If you'd rather share your responses via audio, video, or visual forms, you are more than welcome to do so. If you choose video or audio, please keep your responses to less than two minutes. Most of all, please respond in the way that best allows you to show up fully. (Online voice recorder: https://www.rev.com/onlinevoicerecorder)

Please share a window into your personal story.

Some examples of potential topics are:
○ The people who have impacted your journey
○ The experiences and environments that have shaped your life
○ The ways you spend your time
○ The things that motivate you personally or professionally
○ Why you are excited to apply for VAPLP

Q1) Audio/Video/Visual Response Alternative

Max. file size: 50 MB.

Each learning retreat has its own area of focus bound by a thread that connects them together. Tied, each participant adds their own unique gifts and experiences to our community. What are you looking to take away from the learning retreats? And what do you hope to bring to the pod?

Q2) Audio/Video/Visual Response Alternative

Max. file size: 50 MB.

We anchor in Deepa Iyer’s Social Change Ecosystem Map. Take a peek at the ecosystem with the link below. What two to three roles describe you best and why? How do those roles connect to the community work you’re doing now or aspirationally?

Social Change Ecosystem Map: https://docs.google.com/document/d/1MNbfvYNekWeF6fyXtJ6VpPzr33cJH1ET9LkmmX_RWeg/edit?usp=sharing

Q3) Audio/Video/Visual Response Alternative

Max. file size: 50 MB.

With the current systemic, organized onslaught of attacks on trans youth and bodily autonomy, and as an organization based in Richmond, the former capital of the Confederacy, and in Virginia, one of the first sites of colonization and slavery in the US, we are especially committed to and responsible for combatting all forms of oppression, white supremacy, and injustice. In your personal and professional life, how do you move forward equity & social justice?

Q4) Audio/Video/Visual Response Alternative

Max. file size: 50 MB.

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