Anima Leadership Sliding Scale Application Form

First Name *

Last Name *

Email Address *

Phone Number *

Which Anima Leadership course are you interested in attending?

Please give us a brief summary of what interests you about this program

What specific goals and objectives do you hope to achieve in this program? How would it fit into your professional development?

Do you identify as a member of an equity-seeking group?

No

Yes

If you identify as a member of an equity-seeking group, please specify

Are you affiliated with an organization? Please specify

If you are affiliated with an organization, would the organization be financially supporting your enrollment in this course?

Please let us know what amount you were hoping to contribute to your registration in this program