Application

Name *

Nickname/Preference *

Address *

City *

State *

Zip *

Email *

Best Phone *

Is this your: *

Where do you work or go to school? *

Do you have children? *

If yes, how many and what ages?

Will you require childcare during classes? (We do our best to accommodate busy working moms!)

Do you hold a college degree? *

List your degree(s), date of graduation, college(s)

Do you sit on any Boards or have any professional affiliations? Please list them and your title.

Political Party Affiliation

Do you vote regularly? *

Do you fully support all 10 points of the Women's Equality Act? (for details visit the Blog on this website)

Why are you applying for the WomenElect program? *

Have you had any previous campaign experience? *

What issue are you most passionate about and what experience or education do you have that helps you to advocate for this issue? *

In what ways are you involved in your community? *

What else should we know about you?

If you are a human and are seeing this field, please leave it blank.