First Name

Last Name

Email Address

Phone

Country

With which gender do you affiliate? With which gender do you affiliate? Male Female Non-binary Prefer not to answer

Which category best describes you? (Based on the United Nations Geoscheme. Check all that apply.) Which category best describes you? (Based on the United Nations Geoscheme. Check all that apply.) Africa- North African Africa- East African Africa- Middle African Africa- Southern African Africa- West African Americas- Caribbean Americas- Central American Americas- North American Americas- South American Asia- Central Asian Asia- East Asian Asia- South Asian Asia- Southeast Asian Asia- West Asian Europe- Eastern European (including Northern Asia) Europe- Northern European and Channel Island Europe- Southern European Europe- Western European Oceania- Australian or New Zealand Oceania- Melanesian Oceania- Micronesian Oceania- Polynesian Other culture/ethnicity/origin Unknown Prefer not to answer

This scholarship provides opportunities specifically for women who may (not required) also identify with other marginalized communities. Examples include race, culture, ethnicity, gender, sexuality, neurodiversity, and others. How does this apply to you in your career journey?

Please share your desired professional trajectory. What are the goals/roles/outcomes of your career in terms of next 2 years? 5 years? 10 years?

What do you hope to gain from this course?

Are you willing to commit to communicating with One In Tech for two years after this scholarship is awarded regarding your career status? Are you willing to commit to communicating with One In Tech for two years after this scholarship is awarded regarding your career status? Yes No

By submitting this form, I hereby request to be considered for the One In Tech Diversity in Leadership Scholarship. By submitting this form, I hereby request to be considered for the One In Tech Diversity in Leadership Scholarship. I confirm I wish to be considered for the One In Tech Diversity in Leadership Scholarship.