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Jubilee Application - Southern New England UCC Cohort
Complete the following to the best of your ability. Please send any additional information or questions to
info@justiceleadership.org
with the subject line "Application: (Your Name)."
Thank you for your application to Jubilee!
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* Indicates required question
Application Date
*
MM
/
DD
/
YYYY
First Name
Your answer
Last Name
*
Your answer
Preferred Called Name
Your answer
Preferred Pronouns
*
She/her
He/his
They/them
Other:
Required
Email Address
*
Please type twice to avoid errors
Your answer
Mailing Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip code
*
Your answer
Phone number. Please specify home or cell.
*
Your answer
Are you able (and do you want) to receive texts on your cell number?
*
Yes
No
Do you need assistance with accessibility for any of the following?
Audio
Visual
Internet
Other:
How did you hear about Justice Leadership Jubilee?
Email
Conference Newsletter
Annual Meeting
Local Church Clergy/Bulletin Announcement
Facebook
Someone I knew went through the program or suggested it
Other:
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