First Name
*
Last Name
*
Email Address
*
Phone Number
*
What are your pronouns?
*
Are you currently located in Chicago, IL, or are you prepared to relocate?
*
Yes, I am currently a Chicago resident, or within a commuting distance that would support a daily commute from neighboring communities.
No, but I am willing to relocate.
Voluntary Demographic Information: Avra invites candidates to share voluntary and confidential demographic information to support thoughtful and responsible search processes. When reviewed in aggregate, this information helps strengthen outreach, reduce barriers, and contribute to more inclusive search outcomes for both candidates and the organizations we serve. Individual responses remain confidential and are not used to evaluate candidacy or inform hiring decisions.
*
I acknowledge this information.
Gender: What best describes you?
*
Female
Male
Transgender
Intersex
Non-binary
Prefer not to answer
Race and Ethnicity: How do you identify your race or ethnicity? Select any that apply.
*
American Indian or Alaska Native
Asian
Black
East Asian
Hispanic, Latino/a, or Latinx
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
South Asian
Southeast Asian
White
Another race or ethnicity (please specify below)
Prefer not to answer
(Optional) Another race or ethnicity:
Veteran Status: Do you identify as a veteran of the U.S. Armed Services?
*
Yes
No
Disability: Do you identify as a person with a disability?
*
Yes
No
Work Authorization: Are you authorized to work lawfully in the United States?
*
Yes
No
How did you hear about this role?
*
Outreach from Avra Search Partners
Current or Former Board Member (please list below)
Job Board (please list below)
Outreach from Hiring Organization
Referral (please list below)
Linkedin or Other Social Media
Other
Name of the referral, board/staff member, or job board:
Is there any additional information that you would like to share to demonstrate your alignment with the expectations of the CEO role or the mission of Brave Space?
Yes, Avra Search Partners can contact me about job opportunities.
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the privacy policy
and
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. For help, email
support@loxo.co
.