Halloran Fellowship Application

Step 1 of 3 - Your Information

Name*

First Last

Email*

Tell Us About Yourself

Our organization values diversity. The collection of demographic information is essential to us as it helps us ensure that our processes are fair and inclusive. Our objective is to make certain that our programs fully represent and cater to the diverse populations we work with. We invite you to voluntarily provide demographic information below.

Country of Citizenship*

Phone*

Date of Birth*

Gender Identity*

Other, Gender Identity*

Pronouns*

Other, Pronouns*

Race*

Other, Race*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

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I affirm that I live/work in and around Bradford, Pennsylvania, as this is a place-based fellowship

What is your highest level of education?*

School Information*

High school, university, vocational school, community college etc.

Name of School Location (city, country) Dates Attended (year-year)

Share your LinkedIn Profile*

If you don't have a LinkedIn profile, please put N/A

How did you first learn about the Halloran Fellowship*

Please select one option below of how you first learned about the Fellowship. For additional options or description, please use the elaborate on your answer question below.

Please elaborate on your answer to the question above.*

Please be specific, for example: if referred, (tell us the full name of the person and Organization); if you marked a Social Media Group, (give us the name of the group); if it’s through social media referral either a post or newsletter, (give us the name of the Social Media page, and Organization); If you saw it in one of the opportunity websites, (share if it was through a social media post, newsletter or on their website). We want to know how you learned about the Fellowship program.

Have you previously participated in a similar Fellowship or Accelerator program?*

Provide a list of Fellowship programs you have participated in, including the dates of your involvement in each.

Have you ever participated in any Watson Institute’s Fellow-led Basecamps?*

Provide a brief biography*

Write this section from a third-person perspective, detailing their background, mission, and the impact they aspire to make in their community and the world.

Halloran Fellowship Application

Equipping aspiring entrepreneurs and leaders in and around Bradford, Pennsylvania with the skills, resources, and experience to scale their impact.

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