Name *

First Name

Last Name

Phone Number *

(###)

###

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Name *

Parent/Guardian

First Name

Last Name

Phone *

(###)

###

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OPTIONAL Video *

We understand that writing isn’t everyone’s preferred communication medium. If you’d like to submit an optional 2-minute, unedited video describing your story/idea please email to team@collabnewhaven.org with the subject line: “[Your Name] - Accelerator Application” and indicate below whether you are or are not submitting the optional video. Not submitting a video will not affect your written application's evaluation.

Yes, I am submitting a video!

No, I am okay with just submitting my written application.

To which gender identity do you most identify with? *

Female

Male

Non-binary / gender non-conforming

Prefer not to say

What is your race/ethnicity? *

Asian

Black/African American

White

Latinx/Hispanic

Native American of Alaskan Native

Not listed here

Program Dates *

Please check the box to confirm that you have reviewed the mandatory program dates and can make it to all sessions including the Showcase, or you have emailed team@collabnewhaven.org to discuss special circumstances. Dates are in the above hyperlink.

I have reviewed the mandatory program dates