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)."
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Application Date
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DD
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First Name
Last Name *
Preferred Called Name
Preferred Pronouns *
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Email Address *
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Mailing Address *
City *
State *
Zip code *
Phone number. Please specify home or cell. *
Are you able (and do you want) to receive texts on your cell number? *
Do you need assistance with accessibility for any of the following?
How did you hear about Justice Leadership Jubilee?
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