Cart
0
About
Get Involved
Impact
News
Events
Contact
Donate
Back
About Us
Our Mission
Our People
Back
Initiatives
Programs
Volunteer
Sponsorships
Join Our Team
Cart
0
About
About Us
Our Mission
Our People
Get Involved
Initiatives
Programs
Volunteer
Sponsorships
Join Our Team
Impact
News
Events
Contact
Changing Places, Changing Lives
Donate
Urban Fellows Acceptance
Name
*
First Name
Last Name
Your Email Address
*
Best number to reach you at
*
(###)
###
####
Parent Name
*
First Name
Last Name
Parent Email Address
*
Parent Phone Number
*
(###)
###
####
Do you accept your spot in Groundwork Bridgeport's Urban Fellows Program?
*
Yes
No
Will you be able to attend the info session for the Urban Fellows Program on Wednesday, December 5th at 5:00 pm. The info session will be held at 1001 Main Street, Suite 18, Bridgeport, CT 06604.
*
Yes
No
Please confirm which group you are available to participate in?
*
If you are available for both please select both options.
Monday/Wednesday from 3:30 to 6:00 pm
Tuesday/Thursday from 3:30 to 6:00 pm
Thank you for completing the Urban Fellows Acceptance form!