Thank you for your interest in being featured as a current trainee, former trainee, or early career professional on the 2023-2024 Emerging Leaders Map! The AUCD Emerging Leaders Map highlights current and former trainees' contributions across the AUCD network.

This year's theme is "Celebrating Inclusivity Across Communities"

If you have any questions about this process or need assistance filling out this form, please email Mollie Blafer at mblafer@aucd.org.

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* 1. Full Name (First and Last)

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* 2. Email

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* 3. What type of trainee are/were you? (Please select all that apply)

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* 4. Were you a trainee between August 2023 to now?

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* 5. Which AUCD member center or program are/were you located at? The list below is ordered by state abbreviation. If you don't see your center/program, please email Mollie Blafer at mblafer@aucd.org

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* 6. What is/was your discipline? Examples include self-advocacy, family, social work, occupational therapy, psychology, medicine, genetic counseling, etc.

The 2023-2024 Emerging Leaders Map will focus on "Celebrating Inclusivity Across Communities"

We are highlighting stories of inclusion and fostering a sense of belonging - celebrating the unique contributions of AUCD’s Network Emerging Leaders Community, who work towards greater inclusion in their fields of work and places of study.

Please answer 2-3 of the following questions based on this year's theme. Please limit your responses to no more than five sentences for each question. Submissions without responses to at least two questions will not be highlighted on the map.

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* 7. How do you see inclusivity in your community or the groups you're a part of? How do these stories of diverse people working together make the community stronger?

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* 8. How can you make sure places in your community are inclusive?

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* 9. How does your center or program foster a sense of belonging? Tell us specific things that have worked.

Demographic Questions - The next few questions are about you and how you identify yourself. 

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* 10. Please provide a brief bio about yourself. No more than five sentences. Use third-person language, don't use "I."  You can include:
  • Home city/state, if different from the program's city/state
  • Academic degrees awarded
  • Current or previous job roles 
  • Non-academic interests or hobbies

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* 11. Which gender do you identify with? (select all that apply)

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* 12. Which of the following best describes you? (select all that apply)

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* 13. What is your relationship with a disability? (select all that apply)

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* 14. Please upload a headshot of yourself.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 15. Please provide a brief image description of your headshot. An image description tells people what is in the image. For example, what you look like or what you are wearing. Click here to learn more about how to write an image description.

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* 16. Social Media: Please list your social media accounts if you want them to appear on the map. This is optional.

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