Faculty Scholarship Application Form for the A2MEND 18th Annual African American Male Summit

The Academic Senate Foundation is proud to offer scholarships for faculty to attend the A2Mend 18^th Annual African American Male Summit on March 5-7, 2025 at the Hyatt Regency LAX Hotel. The scholarship will cover the cost of registration, hotel, and up to $300 in travel costs.

Details about the deadline are at the bottom of this application form. If you are a selected winner of the scholarship, you will be notified by us at foundation@asccc.org and the scholarship award will be provided as a reimbursement AFTER the conference date.

Name

First

Last

Email

College

Academic Senate President Name

Cell Phone

Discipline

Other College not listed

Academic Senate President Email

Application Questions

1. Are you planning on attending any of the four Pre-Conference options?

Women’s Leadership Institute, Career Pathways Pre-Conference, Co-Conspirator Pre-Conference, OR A Humanizing Math Experiences for Black Male Students Pre-Conference

2. Have you previously received a scholarship from the Foundation for ASCCC during the academic year of 2023 or 2024?

Yes
No

3. What is your role with your local academic senate?

4. What do you seek to gain as a result of attending A2MEND?

5. How will what you gained during the conference help in your work with students?

6. How will what you gain help you advance as a faculty leader?

7. How could your involvement in this conference improve your local senate or local faculty leadership?

Optional Information

The ASCCC aims to intentionally support the increase of development opportunities for diverse faculty, as called for in the ASCCC Strategic Plan 2018-2023 Goal 2 Objective 2.1. In order to design and lead professional development opportunities for diverse faculty, it is essential to begin gathering data to identify and meet the needs of the diverse faculty in our community college system. We ask that you please consider answering the following optional questions to help us identify the needs of our diverse faculty. Please know that we value your voice and confidentiality, and this information will be secure and not shared or published without permission.

8. With which racial/ethnic group(s) do you identify? (check all that apply)

Other racial/ethnic group

9. What is your sexual orientation? (check all that apply)

Other sexual orientation

10. What is your current gender identity? (check all that apply)

*(Cisgender is defined as a person whose gender identity aligns with their sex assigned at birth) **(Gender non-conforming is defined as a person whose behavior or appearance does not conform to traditional gender expectations) ***(Transgender is defined as a person whose gender identity and/or expression is different from their sex assigned at birth)

Other gender identity

The deadline to submit is February 3, 2025 at 5:00 PM (PST). Selected faculty will be notified via email two week after the submission date.

Signature

I hereby declare that the information provided is true and correct.