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Vot-ER Civic Health Fellowship Interest Form

Applications for the 2025 Civic Health Fellowship have closed. Complete the form below to get notified when applications reopen for 2026!

Vot-ER Civic Health Fellowship is an 8-month online program that equips healthcare professionals like you with the training, resources, and collaborative space needed to lead campaigns that mobilize patients towards civic engagement.

In order to be accepted into the Fellowship, you need to apply as part of a team at your institution or association. If you need support with building a team or have any other questions before applying, you can reach out to Leah Ford at [email protected] for support.

First Name

Last Name

Email

Employer or School

If your organization is not listed, select "Other"

Does your organization primarily serve patients who identify as any of the following? (Check all that apply)

24 years old or younger.

Medicaid/CHIP eligible or do not have health insurance.

Self-identified as Black/African American.

Self-identified as Hispanic/Latino/e.

Self-identified as Native American/Alaskan Native.

Individuals with physical/mental/emotional disabilities.

Individuals in rural communities.

Best served in a language other than English.

I am not in a patient-facing role/organization.

None of the above apply.

State

Zip Code

Occupation

If your occupation is not listed, select "Other"

Phone Number

Untitled checkboxes field

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