2026 Roots and Rising

Name

First NameLast Name

Pronouns

Sexual Identity

Email

example@example.com

City

State

Field of Work

Leadership Role

I embrace my leadership role with confidence, fully owning my identity as a Black queer man.

1 is Least, 5 is Best

I have successfully networked with other Black queer men in leadership roles.

1 is Least, 5 is Best

I have had the privilege of mentoring and supporting other Black queer men who aspire to pursue leadership roles similar to mine.

1 is Least, 5 is Best

I have a queer mentor.

I have/had a queer coach.

How did you hear about the leadership cohort?

Executive/CEO/Senior Leadership Participant

For those participating that are in higher leadership roles. Including leadership roles in education (IE Principal, Grade Level Chair)

$49.00 Quantity

Directors and Managers Participant

For those participants that lead teams but aren't in higher leadership roles. Including Teachers.

$39.00 Quantity

Entry Level Participant

For those participants that have just stepped into smaller impact leadership roles.

$29.00 Quantity

Undergraduate College Student Participant

For those participants in undergraduate leadership positions on campus.

$20.00 Quantity

Servant Leadership Participant

For those participants who really can't afford it but need this space in order to grow.

$20.00 Quantity

Enter coupon

Subtotal

Tax

Total

Payment Methods

Debit or Credit Card

Klarna