Name

First Name

Last Name

Pronouns

Location and Land

Where you reside

What is your current bio (as it relates to your goals for this program)?

For example you may be a photographer but want to focus on another business for this program. Please share about the focus.

How long have you been doing this work?

How do you contribute a diverse perspective in the field that you work in?

Describe any relevant aspects of your identity.

How does your intersectionality play a part in your work?

Where are you on your social justice journey? Would you describe yourself as an ally? An accomplice? A Key stakeholder?

What are your top three desired outcomes from this program?

What technical apps are you familiar with using for your work?

Name the most used

Describe your relationship with Tejal and Tejal’s work.

Hi! I can't wait to deepen our relationship or meet you anew!

Do you foresee any disruptions to your ability to dedicate your time? Are you working around any scheduling issues?

Please note: this program is high-touch over a 3 month period. To get the most out of the program, please prioritize your attendance.

Please complete the following: I am choosing to work with Tejal because: