ACRE Co-Lab Application - Impact Alamance

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ACRE Co-Lab Application

Before submitting, please visit Impact Alamance's website to review the program description, requirements, and application and selection process. We look forward to reading your applications!

Participation in the program requires a commitment to attend 12 half day sessions (most sessions from 9am until 12pm and some until 2pm) between August - December 2026. Dates are listed on the website. Are you committed to attending and participating fully in the program?*
Personal and Demographic Information
Name*
First Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Race/Ethnicity*
- Asian/Pacific Islander
- Black/African-American
- Latino/a/x or Hispanic
- White/Caucasian
- Native American/American Indian/Indigenous
- Biracial/Multiracial
Phone*
Gender*
Birthdate
Generation*
- 1946 to 1964: Baby Boomer
- 1965 to 1980: Generation X
- 1981 to 1996: Millennial
- 1997–: Generation Z
Years of Residence in Alamance County*
Years of Working in Alamance County*
Please list any local community involvement (organization name, dates involved and any leadership positions held)*
Current Organization*
Title/Position*
Supervisors Name*
Short Essay Response Questions (3-5 sentences)
What experience, perspective, or life journey has shaped your interest in participating in ACRE?*
What is one challenge or opportunity related to belonging, equity, or community that you care deeply about? How do you hope ACRE will help you advance progress on that issue?*
ACRE invites participants to engage in honest dialogue, self-reflection, and perspectives that may challenge their own. What do you hope to learn from others in the cohort?*
If you work for an organization or nonprofit, please attach an endorsement letter from your board chair or supervisor stating that they support you in participating in all of the ACRE CoLab sessions.
Max. file size: 50 MB.

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© 2023 IMPACT ALAMANCE

133 E Davis St, Burlington, NC 27215

(336) 221-0011

ImpactAlamance@conehealth.com

Impact Alamance is a foundation formed from the merger between Alamance Regional Medical Center and Cone Health.

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