LEAP Program Home > LEAP Program (2024) > LEAP Program Scholar Application LEAP Scholar Track Application Application Deadline: 11-06-2024 LEAP Scholar Track Application (2024) JCOIN Capacity Building Core Research Education Application - Scholar Track Name* First Middle Name/Initial Last Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip E-mail Address* Degree(s)If applicable, please list your degree(s) below.Current Position*Institution*Please provide a description (in 350 words or less) of your professional goals for participating in the JCOIN LEAP Scholars program and indicate how the program will further your current work at the intersection of health and the criminal-legal system.*Gender* Male Female Gender Queer/Gender Non-Conforming Different Identity (please specify) Prefer not to answer Please specify*Race/Ethnicity (please select all that apply)* American Indian/Alaska Native Asian Black/African American Hispanic/Latino(a) Native Hawaiian/Other Pacific Islander White Other (please specify) Please specify*I was the first person in my immediate family to graduate from a four-year college.*TrueFalseWe are interested in your life experiences that will contribute to your contributions as a LEAP participant to JCOIN’s mission. As such, please complete these questions.a. Please describe any leadership roles, life experience, community service or experience with diverse populations that have enhanced your leadership and resilience. (200 words)*b. Please describe your skills and attributes, personal qualities and relevant demographic factors that contribute to your candidacy. (200 words)*c. Please describe cultural background, important historical, political and world events that influence your career interest to improve outcomes of justice-involved populations. (200 words)*Upload your resume/CV*Please upload in .txt, .doc, .docx, or .pdf format. Max. file size: 256 MB.Upload a short biography*Please upload a 150-word biography of yourself in .txt, .doc, .docx, or .pdf format. Max. file size: 256 MB.Upload your Reference(s)*Please upload a document with the name, title, and contact information of your reference(s) in .txt, .doc, .docx, or .pdf format. Max. file size: 256 MB.Upload your photoPlease upload your headshot photograph (optional). The file should be .jpg, .gif, or .png format and at least 450px. This will not be part of the review process and is not required. This is requested so we may publish scholarship recipients on signage at the conference.Max. file size: 256 MB.CAPTCHA Δ
