Phoenix Rising Collective Application

Intro text Heading link

Please send questions to Ramona Gupta at ramonag@uic.edu.

Student Organization Name: * Required
President's Name: * Required
President's Email: * Required
Designated Representative's Name: * Required
(Can be the president or another officer)
Designated Representative's Pronouns: * Required
Designated Representative's Title:
Designated Representative's Email: * Required
Additional Officers: * Required
Please share the Name, Title, and Email Address of your other officers. You can click on the plus (+) sign to add additional rows.
Name Title Email
Advisor Name: * Required
Advisor Email: * Required
How has your organization demonstrated (or how does your organization aspire to demonstrate) a commitment to women's leadership and/or gender equity? * Required
I confirm that our Designated Representative is available for the scheduled Fall 2021 Collective meetings: Thursday, September 30, October 21, and November 18 at 3-5pm CT. * Required
- Yes
- No
Questions or comments:
Please let us know if you have any additional comments or questions.
Name of person submitting this form: * Required
Email address of person submitting this form: * Required

Name	Title	Email