2015 Seeding Change Fellowship
Fellowship Application Form
This document is for your reference only. Please complete the application online at: http://www.seedingchange.org/programs/fellowship/2015application/. If you have any problems submitting your application
and resume, please contact Le Tim Ly at support@seeding-change.org
I. Personal Information
1. Contact Information
First Name:
Last Name:
Phone Number:
Email Address:
2. Current Mailing Address
Address:
City:
Zip:
State:
3. Permanent Address (if Different)
Address:
City:
Zip:
State:
4. Demographic Information
Race/Ethnicity:
Self-Identified Gender:
5. Availability
First Day Available for Fellowship:
Last Day Available for Fellowship:
6. Do you have a valid driver's license and/or access to a vehicle? (Note this is NOT a
requirement)
Yes
No
7. Please rate your ability in each language (i.e. understand, speak, read, write).
Example:
Spanish: fluent in reading, writing, and speaking
Cantonese: conversational speaking only
8. Academic Information (if applicable)
School Name:
Major/Degree:
Expected/Actual Graduation Date:
II. Short Response Questions
1. What is your vision of an ideal society and how does it compare to what we have
today?
2. What type of work do you want to pursue in the future and why?
3. Describe in detail your current and past involvement with community,
religious/spiritual, political, social justice, and other groups.
4. Describe a time/experience in your life when you have displayed leadership.
5. What in your life experience has influenced your views of social change and your
desire to become an activist or organizer?
6. How do you relate to the struggles facing working-class AAPI communities?
7. What do you hope to gain by participating in this Fellowship? Describe which
skill areas you hope to most develop.
8. How did you hear about the fellowship?
Do you have access to scholarships/work-study/stipend through any program that you are
a part of? If so, please describe. If not, please let us know what kind of needs you have
for income/employment over the summer.
Site Preferences:
The Aikea Movement (Oahu, HI)
Asian Pacific American Network of Oregon (Portland, OR)
Asian Pacific Environmental Network (Oakland,CA/Richmond,CA)
Asian Services in Action, Inc. (Akron, OH)
Boat People SOS – Delaware Valley (Philadelphia & South New Jersey)
CAAAV Organizing Asian Communities (New York, NY)
Chinatown Community for Equitable Development (Los Angeles, CA)
Chinese Progressive Association Boston (Boston, MA)
Chinese Progressive Association San Francisco (San Francisco, CA)
DRUM South Asian Organizing Center (New York, NY)
Filipino Advocates for Justice (Oakland & Union City, CA)
Filipino Community Center (San Francisco, CA)
Khmer Girls in Action (Long Beach, CA)
Ugnayan Youth for Justice and Social Change (New York, NY)
Veggi Farmers’ Cooperative (New Orleans, LA)
Vietnamese American Young Leaders Association of New Orleans (New Orleans, LA)
Site #1:
Please share why you would like to be at this site.
Site #2:
Please share why you would like to be at this site.
Site #3:
Please share why you would like to be at this site.
III. References
1. Please list 2 references and their contact information below, including their emails and
phone numbers.
Please prepare a resume to upload on the application.