Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 5PERSONAL PROFILE In this section we would like to learn more about you! Name *FirstLastEmail *Cell Phone *Best number for receiving calls and text messages.Date of BirthMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920GenderMailing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextORGANIZATION / GROUP PROFILE In this section we would like to learn more about your organization, network or group. Name of OrganizationRole or Titlewhat role or position do you hold within the organization or group?MissionTell us about your mission and the values that drive your work.Organization or Group Social Media Sites Please feel free to provide any websites or social media accounts you would like to share with us to help us get to more about the organizations or groups you are associated with! Organizational Social Media and LinksPersonal Social Media Sites Please feel free to provide any websites or social media accounts you would like to share with us to help us get to know you better! Personal Social Media and LinksNextELIGABILITY & COMMITMENTS As a Chicago Peace Fellow, you will be asked to commit an average of 5 hours per week to share with peers through an interactive learning platform as well as attend weekly sessions between March - November, 2025. Can you commit to spend an average of 5 hours per week over the eight months of the Fellows Program? *SelectYesNoUnsureCan you commit to attend the weekly meetings hosted on Thursdays at noon from March 20 - November 13, 2025? *SelectYesNoUnsureCan you commit to share what you know with a network of peers to learn together as a community of practice? *SelectYesNoUnsureWhat is the PRIMARY neighborhood or community area that you serve? *AustinAuburn GreshamChathamChicago LawnEnglewoodWest EnglewoodGage ParkEast Garfield ParkWest Garfield ParkGreater Grand CrossingHumboldt ParkLower West Side (Pilsen)New City (Back of the Yards)North LawndaleRoselandSouth ShoreWashington ParkWest PullmanWoodlawnCity-WideOtherWhat was the last year you received a grant from the Chicago Fund for Safe and Peaceful Communities? *Have you, your organization or a group you are associated with received a grant from the Chicago Fund for Safe and Peaceful Communities?20242023202220212020201920182017I have not received a grantNextWhy do you want to be a Chicago Peace Fellow? *In 200 words or less, please tell us why you want to be a Chicago Peace Fellow!NextFINAL STEPS Anything else you would like to share with us?Please let us know any questions, suggestions or concerns you may have (optional).Please upload a profile photo of yourself * Click or drag a file to this area to upload. Feel free to upload a resume or other documents like a letter of recommendation that helps us learn more about you. Click or drag files to this area to upload. You can upload up to 5 files. Feel free to upload a video that helps us learn more about you. Click or drag files to this area to upload. You can upload up to 5 files. Thank you for submitting your application! We will review your application and contact you to set up an interview. We look forward to speaking with you and thank you for your interest in becoming a Chicago Peace Fellow. Sincerely, Michael Henderson Director, Chicago Peace Fellows michael@goldininstitute.org Submit
