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Wealth Equity Fellowship Application
This form is to determine your eligibility for the program. All answers will be kept confidential.
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* Indicates required question
What is your first and last name?
*
Your answer
What is your phone number?
*
Your answer
What is your email address?
*
Your answer
What is your full address?
*
Your answer
What is your date of birth?
Your answer
What is your household make up?
*
Head of household
Two income household
How many people are in your household?
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Your answer
What is your current hourly wage?
*
$15-20
$20-25
$25-30
$30+
Unemployed
Receiving public assistance
What is your monthly housing expense (rent/mortgage, electric, gas, water, food, landscaping, etc.)?
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Your answer
Do you have transportation?
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Yes
No
Other:
Do you have a car note?
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Yes
No
Are you a...
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Black Woman
Black Gender Expansive Person
Latina Woman
Latina Gender Expansive Person
Other:
Required
Can you commit to attending a 20 week fellowship on Tuesday nights?
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Yes
No
Educational background
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High school diploma
Bachelor's degree
Masters degree
Certification
GED
Other:
Do you live ...?
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Suffolk County
Nassau County
Other:
Would you be interested in financial fitness/credit repair?
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Yes
No
Maybe
Do you have access to a computer?
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Yes
No
Do you have access to Wifi?
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Yes
No
Would you be available to start the program in March 2025?
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Yes
No
Maybe
What occupation(s) are you interested in?
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Education
Finance
Civil Service
Medical Field
Entrepreneurship
Other:
Required
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This form was created inside of The Women's Diversity Network.
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