2024 Site Coordinator and Assistant Site Coordinator Application

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Full Name

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Email

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This address will receive a confirmation email

Phone

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Address

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Date of Birth & Age

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Gender Identity

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Please select one option.

Female Male Non-binary Decline to state Other

Pronouns

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She/Her/Hers He/Him/His They/Them/Theirs Ze/Zir/Zirs

Race/Ethnicity (check all that apply)

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Please select all that apply.

American Indian or Alaska Native Native Hawaiian or Pacific Islander Asian Black or African American Hispanic/Latinx White Other

Are you a registered voter?

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Please select one option.

Yes No

Current Education Level (check all that apply)

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Please select all that apply.

2-year Associates (or equivalent) 4-year Bachelors Masters Terminal (Ph.D., J.D., M.D., Ed. D. or equivalent)

Name of Undergraduate or 2-year institution

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Name of Graduate Institution (if not applicable, put N/A)

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Please list two emergency contacts: Name, Relationship, Phone

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Please tell us why you wish to be a Site Coordinator/Assistant Site Coordinator.

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Which dates and times would you be available to participate in a virtual interview?

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Please email resume with at least three references to Timesha Moten-Tibbs at timesha@welcometableaustin.org

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Description

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