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Micah Fellows Program - Cohort 3 Application
*
1.
Your Legal Name
(Required.)
2.
Your Pronouns
3.
Please provide your most frequently checked email.
4.
Please provide your phone number.
5.
In what county do you reside?
6.
Address
Street
Street Line 2
City/Town
State/Region/Province
Zip/Post Code
Country
7.
We'd like to collect some information about your context
Affiliated Organization(s) - please separate with commas
Title
Years of experience in your role
8.
Reference One
Please provide name and contact information for two references who can speak to who you are, your skills, and your leadership.
First Name
Last Name
Phone Number
Email
Company/Organization
9.
Reference Two
Please provide name and contact information for two references who can speak to who you are, your skills, and your leadership.
First Name
Last Name
Phone Number
Email
Company/Organization
10.
Micah Fellows Learning Journey Commitments & Events
We ask that you submit your application only if you can agree to hold the following dates available on your calendar for the learning journey.
Virtual Information Session -
Dec 16, 2024, 12pm - 1pm CT
Virtual Micah Fellows Cohort Orientation -
Jan 15, 2025, 12pm CT
In-Person Retreat -
Feb 19, 2025, 6pm - 8pm, Feb 20, 2025, 9am - 4pm CT
In-Person Legislative Day -
March 19, 2025, 9am - 1pm
Virtual Core Teachings -
March 6, 2025, April 9, 2025, May 7, 2025,
Each Core Teaching will be held 1pm - 2pm CT.
Mini Grant Information Session -
June 4, 2025, 12:00pm - 1:00pm, CT
Spiritual Formation Calls -
Beginning in Feb 2025 ending in Aug 2025
Mini Grants -
June - August
2025
Debrief/Evaluation Session -
Nov 6, 2025, 2pm, CT
If you agree to hold these dates, please enter your first and last name to signify your agreement.
11.
How did you hear about the Micah Fellows Program?
12.
Tell us about your work and how you show up as a leader in your community.
Please keep your answer to a maximum of 250 words.
13.
How do you envision the connection between anti-poverty work and healing in your work /ministry with your community?
Please keep your answer to a maximum of 250 words.
14.
Are there anti-poverty policy issues that you plan address to OR are actively addressing as part of your ministry work?
Please keep your answer to a maximum of 250 words.
15.
Are you familiar with ALICE (Asset Limited, Income Constrained, and Employed) Arkansans? Please share your understanding or knowledge about ALICE.
Please keep your answer to a maximum of 250 words.
16.
How are you hoping to grow in your role as a moral leader in addressing anti-poverty work in Arkansas ?
Please keep your answer to a maximum of 250 words.
17.
How would you describe your level of knowledge of and experience with public policy advocacy?
Beginner
Intermediate
Advanced
Expert
18.
Which of the following best describes your primary motivation for applying to Micah Fellows Learning Journey?
To advance my current work
To gain experience
To develop a new skill or expertise
To contribute to the community or society
To be equipped as a spiritual leader
Other
19.
Which of the following best describes your primary motivation for applying to Micah Fellows Learning Journey?
20.
Which of the following best describes your primary motivation for applying to Micah Fellows Learning Journey?
Please keep your answer to a maximum of 250 words.
21.
Do you currently utilize social media? If the answer is yes, which platforms do you currently use, and what are your handles? Please list them below. Ex. Instagram - @micahfellowsar
If you do not utilize social media platforms, are you interested in learning more information about them? Please be specific?
22.
We are aware that Arkansas has broadband deserts in certain areas. Do you have a computer with a webcam and built-in mic, internet connection, and a quiet space to call into monthly video calls?
Yes
No
Maybe
23.
Now that you know more about this opportunity, why do you believe that you (and your community) would benefit from this learning journey experience?
Please keep your answer to a maximum of 250 words.
24.
What is your age group?
While this response is not required, we strongly encourage you to complete them because we would like to collect some demographic data to ensure that we achieve equitable representation across our programs.
18 - 30
31 - 40
41 - 50
51 - 60
61 and better
25.
What is your gender?
While this response is not required, we strongly encourage you to complete them because we would like to collect some demographic data to ensure that we achieve equitable representation across our programs.
Agender
Man
Nonbinary/Genderqueer
Transgender
Woman
Other
26.
What is your sexuality?
While this response is not required, we strongly encourage you to complete them because we would like to collect some demographic data to ensure that we achieve equitable representation across our programs.
Ace/Aro
Gay
Lesbian
Pansexual
Queer
Straight
Other
27.
How do you racially identify?
While this response is not required, we strongly encourage you to complete them because we would like to collect some demographic data to ensure that we achieve equitable representation across our programs.
American Indian or Alaska Native
Black/African
Caribbean/Latin American Native
Eastern Asian
Hispanic or Latin
Native Hawaiian or Pacific Islander
South Asian
Western Asian
White
Other
28.
How do you ethnically identify?
While this response is not required, we strongly encourage you to complete them because we would like to collect some demographic data to ensure that we achieve equitable representation across our programs.
Hispanic or Latino
Not Hispanic or Latino
Other
29.
How would you describe your economic class?
While this response is not required, we strongly encourage you to complete them because we would like to collect some demographic data to ensure that we achieve equitable representation across our programs.
Low-Income
Working-Class
Middle Class
Owning class or wealthy
Other
30.
What is your highest level of education?
While this response is not required, we strongly encourage you to complete them because we would like to collect some demographic data to ensure that we achieve equitable representation across our programs.
some high school
high school diploma
Associate's Degree
Bachelor's Degree
Master's Degree
31.
How would you describe your current spiritual or religious identity/affinity? Please select all that apply.
While this response is not required, we strongly encourage you to complete them because we would like to collect some demographic data to ensure that we achieve equitable representation across our programs.
Agnostic
Atheist
African Traditional Religion
African Diasporic Religion
Baha'i
Buddhist
Christian
Eastern Folk Religion
Hindu
Muslim
North/Central/South American Indigenous Religions
Pagan/Wicca/European Esoteric Tradition
Quaker
Spiritual (non-religious)
Unitarian Universalist
Other
32.
Are you strongly affiliated with a Christian denominational identity? If so, please list it below.
33.
If there are any demographic multiple choice questions that did not capture nuances of your identity that you wish to share, please note that here.
34.
Thank you so much for taking this time to introduce yourself and your work to us. Do you have any additional questions or comments for us?