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Member Application
SINE Member Application
Step
1
of
6
16%
What is your legal first name?
*
First
What is your preferred name?
*
What is your legal last name?
*
Last
Please provide the best email address at which to contact you:
*
Enter Email
Confirm Email
Please provide a secondary email at which we can reach you:
Enter Email
Confirm Email
What is your preferred phone number?
*
Along with email and phone, the program uses text messages to communicate. Checking "Yes" indicates your permission to contact you by cell phone text message. Message and data rates may apply. May we text this number?
*
Yes
No
What is your Date of Birth?
*
MM slash DD slash YYYY
Please select the option that best reflects your gender:
*
Male
Female
Non-Binary
Prefer to self-describe
Prefer not to say
Please describe your gender
*
Please check the option(s) that best identify your Race/Ethnicity. Check all that apply.
*
African
African American / Black
Latinx
Asian
Pacific Islander / Native Hawaiian
Native American / Alaskan Native
Middle Eastern
White
Please share your countries of descent.
Do you identify as Black, Indigenous, and/or a Person of Color?
*
This question helps us to review this feedback with an equity lens by being intentional in acknowledging the experiences and perspectives of BIPOC communities.
Yes
No
Not sure
Please select the option that best describes your age group:
*
Under the age of 18
18-21 years of age
22-25 years of age
26-29 years of age
30-35 years of age
36-40 years of age
41 years of age or older
Please select the option that best describes your marital status:
*
Single
Married
Widowed
Divorced
Separated
Domestic Partnership
Do you have any children or dependents you are responsible for?
*
Yes
No
Please select the option that best describes your income level range:
*
25K = $25,000 USD
Under 25K
Between 25K-35K
Between 35K-55K
Between 55K-75K
More than 75K
Not sure
Please check which of the following best describes your current housing situation:
*
I currently own a home
I am currently renting
I currently live with my parents/guardians
Other
Please briefly describe your housing situation
Please select the option(s) that best describes your relationship to Oregon/SW Washington:
*
From/grew up in/have family in the area
My permanent address is in Oregon/SW Washington
I currently live in Oregon/SW Washington
I attend(ed) college in Oregon/SW Washington
I don't currently have a connection to Oregon/SW Washington
Other
Please select the option that best describes the type of community you grew up in:
*
Rural
Urban
Suburban
Other
Please briefly describe the community you grew up in:
Education Information
What is your highest level of education?
*
Less than a high school diploma
High school diploma/equivalent
Associates Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
From what college did you receive your most recent degree?
*
Eligible members of SINE must be college graduates.
Please share your college graduation date (MM/YYYY):
*
Day is not required.
Month
DD
Year
Please share your specific degree earned:
*
For the above graduation/degree (e.g. BA, BS, BSW, BSS)
Please indicate your major or field of study:
*
For the above graduation/degree (e.g. Engineering, Journalism)
Please share your minor and/or additional certificates obtained (if applicable):
For the above graduation
Please select the option that best reflects your parents’ college attainment:
*
Neither of my parents attended college
One or both of my parents attended some college but did not complete a bachelors degree
One or both of my parents completed a bachelors degree
Career Information
Ability to work in the U.S.
*
U.S. Citizen
U.S. Permanent Resident (Green Card)
Another type of eligible work status
I am not eligible to work in the U.S.
Are you currently working?
*
Yes
No
Please select the option that best reflects your current employment status:
*
Full-time employee
Part-time/temporary employee
Independent contractor
Unemployed
How many hours per week?
*
Please enter a number from
0
to
100
.
What is the name of your current employer?
*
What is your current job title?
*
Please briefly describe your work/training history.
*
This can include educational experience.
Are you currently working in your desired career field?
*
Yes
No
It is a start in that direction
Please select the option(s) that best reflects the primary job grouping you are interested in a career within.
*
This could be job role or industry. Select two max.
Business & Entrepreneurship
Finance & Accounting
Marketing & Communications
Operations & Projects
People & Engagement
Technology
Please select the option(s) that best reflects the secondary job grouping you are interested in a career within.
*
This could be job role or industry. Select two max.
Business & Entrepreneurship
Finance & Accounting
Marketing & Communications
Operations & Projects
People & Engagement
Technology
Residence Information
Please provide the address at which you currently live and we can send you mail
*
Street Address
City
State
Zip Code
If different than your current/mailing address, what is your permanent zipcode?
ZIP Code
In what county do you currently reside?
*
Baker
Benton
Clackamas
Clark
Clatsop
Columbia
Coos
Crook
Curry
Deschutes
Douglas
Gilliam
Grant
Harney
Hood River
Jackson
Jefferson
Josephine
Klamath
Lake
Lane
Lincoln
Linn
Malheur
Marion
Morrow
Multnomah
Polk
Sherman
Tillamook
Umatilla
Union
Wallowa
Wasco
Washington
Wheeler
Yamhill
Have you lived in (what you consider) rural Oregon in the last 10 years? If so, please name the town(s) and length of time
Please check any of the following programs of The Contingent programs you have participated in (if applicable):
*
Emerging Leaders Mentoring
Emerging Leaders Internship
Act Six
Ready to Rise
Ignite Scholars
None of the above
Please share your LinkedIn URL (optional):
Social Mobility Goals
SINE seeks to support leaders of color in professional and financial development. The mentoring experience will have four focus areas: financial education, wealth building, leadership development & career advancement, and civic & community engagement.
Please rank the following that best describes your priorities:
Financial Education & Wealth Building
*
Very Important
Important
Somewhat Important
Not Important
Professional/Leadership Development
*
Very Important
Important
Somewhat Important
Not Important
Building and Belonging to an Inclusive Community
*
Very Important
Important
Somewhat Important
Not Important
How would you rate yourself on your understanding/knowledge of the following:
Financial Education
*
Understanding and ability to use financial knowledge to help set/adjust goals to develop healthier financial habits over time (e.g., budgeting, saving, credit tracking)
Just Learning
Somewhat Developed
Very Developed
Wealth Building
*
The practice of establishing new financial security and wealth-building opportunities (e.g., retirement fund, investment in stocks, savings account, managing debt).
Just Learning
Somewhat Developed
Very Developed
Professional/Leadership Development
*
Just Learning
Somewhat Developed
Very Developed
Civic and Community Engagement
*
e.g. policy-making, advocacy, volunteer work, uplifting BIPOC and marginalized communities, etc.
Just Learning
Somewhat Developed
Very Developed
What do you hope to gain by participating as a SINE member?
*
Why is building wealth important to you? What do you want to achieve related to wealth building in the next 3-5 years?
*
What are you hoping to bring to the SINE member community? What do you hope to gain from the SINE member community?
*
Mentoring Insights
What are areas you feel like you could use support or guidance?
*
Resume/cover letter development
Career planning
LinkedIn creation/updates
Mock interviews
Professional networking
Grad school preparation guidance
401K investment
Homebuying insight
Other
Please select the top 5 qualities you desire in a mentor:
*
Ability to network and find resources
Active listening skills
Availability to devote time
Compassion and genuineness
Confidence and ability to motivate
Honesty and integrity
Industry knowledge
Passion for continual learning
Positive outlook
Resilience and adaptability
Please briefly describe your career goals.
*
Please briefly describe your desire for having a mentor (s).
*
Have you ever been a mentee?
*
Yes
No
How did that impact you?
*
SINE emphasizes a cohort model. SINE Mentoring Circles contain 3 mentors and 6-9 members that meet monthly. This is a requirement to participate in SINE. Do you consent to participating in a mentoring circle?
*
Yes
No
Not sure
Are you available to meet with a mentor(s) at least once a month for 1-2 hours over a 12-month period?
*
Yes
No
What are the best days/times you are available to meet with a mentor? (Select all that apply)
*
Weekday Mornings (7am-12pm)
Weekday Afternoons (12pm-5pm)
Weekday Evenings (5pm-9pm)
Weekend Mornings (7am-12pm)
Weekend Afternoons (12pm-5pm)
Weekend Evenings (5pm-9pm)
Other
If you selected "Other" above, please indicate other days/times you are available to meet.
Do you personally own or have regular access to the following technology?
*
Check all that apply.
Smartphone
Tablet
Laptop computer
Desktop computer
Wireless Internet
How did you first learn about SINE?
*
As part of the SINE program we offer an optional Financial Fundamentals course. If you would like to attend this, please select the potential dates you would be available. Classes will be held in the evenings from 6-7pm Pacific Time.
*
Select all that apply. (Use
CTRL
if on PC, or
CMD
if on Mac)
October: 3, 10, 17
October: 6, 13, 20
November: 7, 14, 21
November: 3, 10, 17
December: 1, 8, 15
December: 2, 9, 16
SINE Survival Is Not Enough Member Agreements
*
WHAT DOES SINE COMMIT TO PROVIDE?
Professional Learning Community
Access to a Strong Job Network
Deep Connections through Mentorship
As a member of the SINE cohort, you make a commitment to your own growth and development and the SINE community. Please confirm that you can agree to the following:
Members agree to complete the required 5-week finance class
Members agree to attend “core circle” meetings
Members agree to attend a minimum of 2 meetups/“middle circle” events
Members agree to complete quarterly mentoring updates
Members agree to take the annual financial wellness scorecard assessment
Members Commitments
Commit to Monthly Saving
Participate in Civic Engagement
Establish Financial & Wealth building Goals
Utilize the SINE resource list to reach their professional goals
I agree to the SINE Member Agreements.
Please sign your full legal name below by typing in the text box.
*
Name
This field is for validation purposes and should be left unchanged.
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