ROMBA Fellowship Interest Form

Please complete this form to notify schools of your interest in the ROMBA Fellowship.

Entries are submitted to schools on a monthly basis.

By completing this form, you consent to Reaching Out notifying schools participating in the Fellowship of your interest and sharing the following information: your name, email, phone and location.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Phone Number (include country code if outside US) *This question is required.

4. Email *This question is required.

5. Where are you currently based (e.g. city/country)? *This question is required.

6. I identify as (your responses will be kept confidential) *This question is required.

7. I identify as (your responses will be kept confidential) *This question is required.

9. If you selected other, please tell us your time frame for applying.