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Vot-ER Civic Health Fellowship Interest Form

Complete the form below to indicate your interest in the 2026 Civic Health Fellowship. After you complete this form, you will receive an email to complete the full Fellowship application. The form you are completing now is NOT your Fellowship application - you will need to complete the full application that is emailed to you.
Vot-ER Civic Health Fellowship is an 8-month online program that equips healthcare professionals like you with concrete tools to address the social determinants of health and implement sustainable nonpartisan civic engagement initiatives at your institution.
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 us at fellowship@vot-er.org for support.

First Name

Last Name

Email

Organization

If your organization is not listed, select "Other"

State

Zip Code

Occupation (Select all that apply)

Occupation (Select all that apply)

Phone Number

SMS_Opt In
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