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Civic Service Fellowship - Interest Form

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Civic Service Fellowship - Interest Form

Thank you for your interest in Rhizome's Civic Service Fellowship - please fill out this form and we'll be in touch!

Fellows will:

Reflect on who you are and want to be
Develop real-world leadership skills
Make a serious, long-term impact
Gain professional experiences
Practice inclusive teamwork
Receive service hours

Once you fill out the form, one of our team members reach out to hear how you want to engage with us!

Full Name *

Preferred Name and Pronouns (if you wish to share)

Grade (2023-2024 school year) *

College-age

Phone Number *

Email *

School (Full Name) *

City *

State *

How did you hear about the Fellowship? *

Through social media

Through receiving a DM

Through a friend in my school

Through a friend in another school

Through a teacher/educator in my school

Through an organization affiliated with Rhizome

Who told you about Rhizome?

In one sentence, why are you interested in becoming a Civic Service Fellow? *

In one sentence, what issues or ideas are you most passionate about? *

We believe lifelong leadership is an outgrowth of deep commitment to civic identities - to connecting the dots between who we are and want to become. If you identify as a member of one or more these groups, please check as many boxes as you see fit.

AAPI (Asian Americans & Pacific Islanders)

Black

Gender Fluid/Nonbinary/Gender Neutral

Latino/Latina/Latinx

LGBTQ+

Mixed Race

Native American

People With Disabilities

SWANA (Southwest Asian, North African)

Women's Affinity Group

Abstain - I do not want to answer this question

We've built Rhizome to be a welcoming space for first and second generation students, as well as for people who come from low-income backgrounds. Please check as many boxes as you see fit. *

First or second generation resident of the United States

First or second generation college student (or aspiring to college)

Grew up in a low income, no income, or lower middle-class environment

Not applicable

Optional: is there anything else you want to tell us? *

Civic Service Fellowship - Interest Form

Click Submit to finish.