Application Form | Wilmers Integrity Prize

About You
Name*
First Last
Organization*
Date of Birth*
MM slash DD slash YYYY
Email Address*
Address*
Address Line 1 Address Line 2 City State ZIP
Twitter Handle
Instagram Handle
LinkedIn Profile

Experience and accomplishments

Respond to each of the three prompts below, using no more than 500 words each:
Tell us about your work.*
(What is it? Why do you do it? Can you share a representative success story associated with your work? What are the major challenges you face?)
Tell us your story.*
(What’s your background? What drives you? What values do you live by? Can you share an example of a time you acted with integrity?)
Tell us about the work’s impact.*
What has been the greatest change in your community due to your work? How do you envision your work continuing to grow in the short-term (three to five years) and long-term (10+ years)? Please be specific and give examples. Be sure to discuss some of the challenges you face, as well as how you believe this award will impact you.

References

Please provide up to three (3) references whom we can contact on your behalf during the selection process. One from your professional life, one from your personal life and one who has been a mentor or mentee of yours.
Professional Reference
Their Name*
Their relationship to you*
Their Position/Title*
Their Email*
Their Phone Number
Personal Reference
Their Name*
Their relationship to you*
Their Position/Title*
Their Email*
Their Phone Number
Mentor/Mentee Reference
Their Name
Their relationship to you
Their Position/Title
Their Email
Their Phone Number

Supporting Materials

Is there anything else we should know about you?

Feel free to send us additional materials that may be helpful for us to understand your work. These can include audio/visual samples, recordings, portfolios, project descriptions or other awards.

If you choose to submit a resume or CV, please include the following:
- Past relevant work experience
- Current role and responsibilities
- Volunteer work
- Traditional or non-traditional education
File uploads (maximum of 3)
Drop files here or

Accepted file types: pdf, Max. file size: 32 MB, Max. files: 3.
A link to a simple video (three minutes in length or less) made on your phone or laptop that explains your mission and vision in your own words so that we can get to know you.*
A link to your personal or professional website or web presence, if you have one.
Expectations.

If you’re selected as this year’s winner, you agree to:
- Allow us to use your name and likeness for promotion purposes
- Attend the award announcement cocktail reception in NYC in November in celebration of your work
- Allow us to conduct a background check or any additional necessary vetting
- Be available for periodic media interviews
- Potentially participate in or moderate panel discussions on integrity
Expectations*
- I agree to the expectations
If you would like to mail your samples to us, please address to:
Jennifer Trainer Thompson
Executive Director
Wilmers Integrity Prize
6 Wendell Street
Mattapoisett, MA 02739

Please include return packaging and postage.
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Apply

Step 1 of 4

About You

Experience and accomplishments

References

Professional Reference

Personal Reference

Mentor/Mentee Reference

Supporting Materials

Expectations.

Now Accepting Applications