Faculty Scholarship Application Form for the A2MEND 19th Annual African American Male Summit

The Academic Senate Foundation is proud to offer scholarship reimbursements for faculty attending the 19th Annual African American Male Student Success Summit, March 5-6, in Long Beach.

Theme: Sacred Work: (Re)membering, (Re)storing, (Re)birthing Black Men and Boys

With a focus on student success, faculty from all disciplines—both full-time and part-time—are encouraged to apply.

The scholarship will cover up to $1,500, which includes registration (main conference only), travel, lodging, and food. The deadline to submit is January 26, 2026 at 5:00 pm (PST). Recipients will be notified within two (2) weeks following the application deadline.

ASFCCC scholarships are provided as reimbursements. Reimbursement will be issued after the conference to allow for any potential changes in plans. To receive reimbursement, recipients must submit valid receipts. If you are a selected winner of the scholarship, you will be notified by us at foundation@asccc.org and again, the scholarship award will be provided as a reimbursement AFTER the conference date.

It is recommended that scholarship applicants register for the selected conference event before completing this form. The ASFCCC does not work for the external organizers.

Name

First

Last

Email

College

Academic Senate President Name

Cell Phone

Discipline

Other College not listed

Academic Senate President Email

Application Questions

2. Have you previously received a scholarship from the Foundation for ASCCC during the academic year of 2024 or 2025?

Yes
No

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

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 January 26, 2026 at 5:00 PM (PST). Selected faculty will be notified via email one week after the submission date.

Signature

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