Fall 2023 Accelerator Program Application

First Name *

Applicant First Name

Last Name *

Applicant Last Name

Title *

Organization *

Email *

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State *

State or Province

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Country *

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Briefly describe why you are interested in the DEI accelerator program. *

What impact will your participation in the Accelerator program have on your company? *

What do you hope to be able to do at your company/organization after completing the Accelerator Program?

What do you hope to learn and/or accomplish through this program? *

Please share any personal or professional goals you have with respect to the Accelerator Program.

Optional: Share your diversity story.

Does your employer support your participation in the CADIA DEI Accelerator Program? *

Yes or No with comment if needed.

Referral

Were you referred by an Accelerator participant or alumni?  If yes, indicate the individual's name and company.

Accommodations

Do you require any accommodation for the Accelerator Program and/or is there anything that you would like to share with the organizers in advance that might help them make your experience more beneficial?