Netroots Nation '21 Scholarship Application

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Does paying for a ticket present a hardship for you? If yes, apply here and we'll consider you for a scholarship with includes a full registration waiver.

Applications scholarships will be accepted until September 30.

Scholarships are limited and intended for those who otherwise would not be able to afford a ticket to attend. Please check all that apply to you. *

I am unemployed or underemployed and would need financial assistance to attend.

I am employed but my employer cannot/will not cover my expenses.

I understand that this scholarship program is intended only for those in true need.

Required

First name *

Last name *

Email address *

Phone *

Current city of residence *

What motivated you to become an activist? *

Why do you want to attend Netroots Nation? *

Demographics

The following demographics questions help us ensure that our scholarships go to historically marginalized communities and those who need financial assistance the most. Your responses will be kept confidential.

How do you describe your gender *

Female

Male

Non-binary

Gender non-conforming

Gender fluid

I prefer not to say

Other:

Do you describe yourself as cis or trans? *

Cis

Trans

I prefer not to say

How do you describe your ethnicity? Choose all that apply

Asian

Black

Hispanic or Latinx

Native/First Nations

Pacific Islander

White

I prefer not to say

Other:

Age *

Do you identify as LGBTQ+ *

Yes

Prefer not to say

Do you identify as a person with a disability or a chronic health condition? *

Yes

Prefer not to say

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