Sabbatical Award Interest Form 2024-2025 – BIPOC ED Coalition of Washington State

REQUIRED ATTACHMENTS.

Upload high-resolution photo(Required)

Accepted file types: jpg, gif, png, pdf, Max. file size: 2 GB.

LinkedIn profile link(Required)

(PDF) Applicant Resume

Accepted file types: pdf, Max. file size: 2 GB.

APPLICANT CONTACT INFORMATION.

Name(Required)

First Last

Title(Required)

Home physical address:(Required)

Street Address City State ZIP Code

Home mailing address if different:(Required)

Same as previous

Street Address City State ZIP Code

Phone:(Required)

Email:(Required)

ORGANIZATION CONTACT INFORMATION.

Organization name:(Required)

Organization website:(Required)

Organization physical address:(Required)

Street Address City State ZIP Code

Organization mailing address if different:(Required)

Same as previous

Street Address City State ZIP Code

Secondary organizational contact other than applicant name:(Required)

First Last

Secondary contact email:(Required)

Secondary contact phone:(Required)

ORGANIZATION INFORMATION.

Mission(Required)

In what region of Washington is your organization’s work based?(Required)

What primary demographic communities does your organization serve?(Required)

Does your organization serve immigrant and/or refugee populations?(Required)

Yes

Board Chair Name

First Last

Board Chair Email

PERSONAL INFORMATION.

We are solely collecting this information for evaluation purposes. It will not impact the decision-making process.

Age(Required)

Gender(Required)

Race/ethnicity:(Required)

Other aspects of identity you wish to share:

QUESTIONS:

Total number of years of nonprofit executive director/senior leadership experience:(Required)

Total number of years in the nonprofit sector:(Required)

Number of years in your current executive director/senior leader position:(Required)

Are you a full-time paid employee of your organization?(Required)

Yes

If not FT, how many hours per week do you work in your role as an ED.(Required)

Annual salary:(Required)

How will your vision for a sabbatical influence your organization?(Required)

What is your vision for a sabbatical and how will it influence your life?(Required)

How did you hear about the BIPOC ED Coalition Sabbatical Award?(Required)

ELIGIBILITY AND CERTIFICATION

To be eligible, applicants must: Be a BIPOC executive director or organizational senior leader with a central decision-making and visioning role. Have a demonstrated track record of social justice commitment and community engagement. Reside in Washington state, with your work centered in Washington state. Have been in a paid, full-time leadership role at your organization for at least five years. Work with an organization that has the capacity to maintain critical operations and programs while the senior leader is on sabbatical. Work with an organization that has 501(c)(3) tax-exempt status or fiscal sponsorship from a 501(c)(3) organization. Have not taken a sabbatical of three months or more in the last 5 years. Share the BIPOC ED Coalition’s commitment to working in solidarity with other BIPOC nonprofit leaders to promote wellness and restore resources in our communities. The organization’s Board of Directors must be in support of the Leader taking the sabbatical, and a Board officer must sign the application.

I confirm my eligibility and have reviewed the Eligibility Checklist above(Required)

Yes

Certification of Accuracy(Required)

I hereby certify that all information in this application is true and accurate to the best of my knowledge.

Name(Required)

First Last

Date(Required)

Phone

This field is for validation purposes and should be left unchanged.