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Increasing the participation of people with disabilities in computing fields

AccessComputing Team Application

AccessComputing Team members

engage in an online community of peers and mentors to help guide you through transitions to internships, graduate school, and employment
receive information from AccessComputing staff about internships, research experiences, scholarships, and other opportunities
attend AccessComputing events and activities communicate with professionals in computing fields
are eligible to receive funding to attend professional conferences or participate in research experiences

Eligibility:

AccessComputing Team members are undergraduate and graduate students who

Have declared or plan to declare a computing-related major such as computer science, information science, informatics, or computer engineering;
Identify as having one or more disabilities; and
Be enrolled as an undergraduate or graduate student at a community or technical college, college, or university in the United States.
International students are welcome to join.

AccessComputing Team Information Form

To join, please complete the following form. Once your form is submitted, you’ll be sent an audio/visual release to sign and return via Docusign. Students under 18 will need to have a parental/guardian form returned. AccessComputing welcomes new participants throughout the calendar year.

This information is used to confirm you meet the participation eligibility guidelines. It also helps us get to know you better and understand what types of support and activities may be most beneficial to you and others.

All information you submit is confidential. Information Forms are on a secure website, and will be removed online when we download files to a private file directory on a secure server. These can only be accessed by a limited number of the AccessComputing staff

While we ask for a copy of your resume to learn more about your background and interests, we do not share your resume or any other information with potential employers.

A print version of this application is also available.

Contact Information

First Name *

Last Name *

Preferred Name, if different from above

Pronouns

Pronouns that should be used to refer to you (optional):

If other please specify pronouns

Address1 *

Address2

City *

State

Zipcode *

Country

Phone *

Main Email *

Other Email

If under 18

If under 18, please complete the following.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Address1

Parent/Guardian Address2

Parent/Guardian City

Parent/Guardian State

Parent/Guardian Zipcode

Parent/Guardian Country

Parent/Guardian Phone

Parent/Guardian Email

Biographical Information

This information help us understand our community and connect you with appropriate opportunities and resources.

Gender

Date of Birth *

Year

Month

Day

Do you identify as having a disability or other chronic condition? *

Yes

No

What is your specific disability?

Ethnicity

Race

American Indian or Alaska Native

American Indian or Alaska Native

Asian

Asian

Black or African American

Black or African American

Native Hawaiian or Pacific Islander

Native Hawaiian or Pacific Islander

White

White

Other Race

Other race

If other please specify race

Veteran of Military Service

Academic Background

Currently enrolled in:

Certificate program

Certificate program

Associate's degree program

Associate's degree program

Bachelor's degree program

Bachelor's degree program

Master's degree program

Master's degree program

PhD program This is used as a desc

PhD program

Name of School/College/University

When will you graduate?

Major

Resume

Paste an up-to-date copy of your resume in the box below, or upload it (.doc, .docx, or .pdf). If you do not have a resume, tell us a bit about your education or work experience.

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Resume Paste

URL of LinkedIn profile

Why are you interested in AccessComputing?

Write a few sentences about why you are interested in participating in AccessComputing and how participation will help you reach your career goals. Sharing more about yourself helps us get to know you better; it can also help us better understand the types of resources we can share with you or conference and research opportunities.

Paste your response in the box below, or upload it (.doc, .docx, or .pdf).

Essay Upload

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Essay Paste

Recommendation

Provide the name and email address of a teacher, faculty member, or someone who has worked with you closely.

Name of Recommender

Recommender Email Address

Participation Agreement

As a member of AccessComputing, you agree to:

Participate in activities and discussions in our mentoring community relevant to your interests.
Respond to emails from program staff.
Notify AccessComputing of changes to your contact information or eligibility for the program.

Participation in AccessComputing may imply you have a disability. AccessComputing does not disclose your disability to others without your consent.

By submitting this form, you agree to these terms. *

I agree

Referral Source

How did you hear about AccessComputing?

Leave this field blank