Application for The Bayard Rustin Residency at The Penington Friends House
The following information will help us determine your eligibility for the residency. Applicants who are selected for further consideration will be asked to provide additional  information including resume, proof of US citizenship, details of project during residency,  and 3 references.

Deadline: MAY 1st, 2021

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Email *
What is your primary phone number? *
What is your full legal name? *
What is your professional or chosen name?
What are your preferred pronouns? *
With what race/ethnicity do you identify? *
Share your tribal affiliation (optional) *
What is your gender? *
Do you identify as a person with a disability? *
What is your date of birth? *
MM
/
DD
/
YYYY
In what city do you currently live? *
State? *
Zip Code ? *
Country? *
What is your preferred method of communication?
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Can you provide a US Passport, or US Birth Certificate, or US Naturalization Certificate, or US Permanent Resident Card, or Non-resident 0-1 Visa? *
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