Name *

First Name

Last Name

Phone *

(###)

###

####

Are you over 18 years of age? *

Yes

No

What borough(s) do you live or work in? *

Bronx

Brooklyn

Manhattan

Queens

Staten Island

Leadership Network members can focus on Grantmaking (reviewing grant proposals and participating in site visits) and/or Mentorship (meeting 1-on-1 with Incubator participants). Select the area(s) of engagement that you’re interested in. *

Grantmaking

Mentorship

Guidelines - Please review the guidelines below carefully. *

I commit to making reasonable efforts to attend all Leadership Network meetings and events during my term including Kickoff (January), Grantee Partner Event (April), Social (August), GlassBreaker Celebration (November) and Holiday Party (December)

If Grantmaking selected, I commit to attending grant review meeting (September) and up to 2 in-person site visits (June & July).

If Mentorship selected, I commit to attending 2-4 virtual meetings with incubator participants (May-September) as well as the pitch competition (October)

I have no conflicts of interest that would prevent my participation in the Leadership Network.

I agree to sign a confidentiality agreement as part of my participation in the Leadership Network.

I agree to sign a non-solicitation agreement as part of my participation in the Leadership Network.

How did you learn about Amplify Her Foundation?

Word of Mouth

Social Media

Internet Search/ Website

Newsletter

Amplify Her

Other