Community Health Leadership Fellows (CHLF) Interest Form

Thank you for your interest in the Community Health Leadership Fellows (CHLF) Program. This interest form helps us learn more about you, your background, and your interest in community health leadership.

Please take your time to thoughtfully and thoroughly answer each of the required questions. Your responses will help us better understand your passion, experiences, and readiness for the program.

All interest forms must be submitted by January 16, 2026 at 11:59 PM CT.
Late or incomplete submissions may not be considered.

We appreciate your interest and look forward to reviewing your responses.

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First Name: *
Last Name: *
Phone Number: *
Email: *
Address: *
Race: *

Are you currently enrolled in an undergraduate degree program at a college or university?

 *

What college or university do you attend?

 *

What is your current major or area of study?

 *

Please share your expected graduation year?

 *

The program will run from February 1, 2026-June 30, 2026. Please confirm your availability to participate throughout the program period.

 *

In a few sentences, tell us who you are, including anything about your background, values, or experiences that you feel best represents you.

 *

Why are you interested in the Community Health Leadership Fellows (CHLF) Program?

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Is the interplay of health and community important to you? If so, why and how has that shaped your interests or experiences?

 *

How do your background, experiences, and skills uniquely position you to contribute to the Community Health Leadership Fellows (CHLF) Program?

 *

How did you hear about the Community Health Leadership Fellows (CHLF) Program?

 *
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