Alumni M-Pact DEI Certificate Program Application

First Name

Last Name

U-M Campus Attended

School or college attended at U-M

Most recent graduation year from U-M

Highest degree you received from U-M

Are you a Rackham graduate?

YesNo

Are you a member of the Alumni Association?

YesNo

Country of Residence

State/Province

Field of Employment

What are three terms you would use to capture key aspects of your identity?

Term 1:

Term 2:

Term 3:

Why do you want to participate in this program and what do you hope to gain from your experience?

Please describe an initiative that you plan to work on while you are participating in the Alumni M-Pact DEI M-Pact Certificate program? (500 words or less; in the spirit of continual learning, note that the plan does not have to be fully developed and may change throughout the course of your participation.)

Please select a category for your initiative:

Please specify: