National Juvenile Justice Network | 1

Youth Justice Leadership Institute

Building a Movement

Application Form 2015

Please complete all of the fields below. Complete applications must be submitted to NJJN no later than 11:59PM Eastern time April 6, 2015. All application components must be received by this deadline for the applicant to be considered.

Submit the completed application packet via e-mail to:

Diana Onley-Campbell

Youth Justice Leadership Institute Coordinator

National Juvenile Justice Network

Please direct any questions or concerns to Diana Onley-Campbell at the National Juvenile Justice Network, at (202) 467-0864 x112 .

Personal Contact Information

Name:

Mailing Address:

Preferred Phone:

( )home ( )work ( )cell

Secondary Phone:

Preferred Email:

1319 F St. NW, Suite 402 • Washington, DC 20004 • 202-467-0864 • •

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Personal Identifiers

How do you identify yourself? Check all that apply.

__ Arab/Arab American

__ Asian/Asian American

__ Black/African American

__ Black/African Caribbean

__ Latino/Latina

__ Native American/American Indian/First Nations

__ Pacific Islander

__ Multi-racial

__ Male

__ Female

__ Transgender

__ LGBTQ (Lesbian, Gay, Bisexual, Transgender, Questioning)

Other:

How have you experienced the juvenile justice system? Check as many as apply.

__ As a young person who was arrested, in court, detained, and/or incarcerated

__ As a parent, guardian, or family member of a young person going through the system

__ As a public policy advocate

__ As a lawyer/legal assistant/court advocate

__ As a youth or community organizer

__ As a student/in the course of study

__ As a researcher

__ As a journalist/documentarian

__ As a social worker

Other:

Please attach your resume or CV.

Please answer the following questions. You are not limited to the space provided, but your answers should be no more than 2 paragraphs in length. You may also attach supporting documents, such as news articles, etc.

  1. Please describe your personal experience working to transform, navigate or survive the juvenile justice system. If you do not have personal experience with the juvenile justice system, please describe your experience in a related social justice field.

1319 F St. NW, Suite 402 • Washington, DC 20004 • 202-467-0864 • •

National Juvenile Justice Network | 1

  1. Why do you want to be a Youth Justice Leadership Institute fellow? What do you hope to gain from your participation?
  1. What, if any, juvenile justice organization(s) are you currently connected to? What is your role there? If you are not currently connected to a juvenile justice organization, please explain your current connections to an organization or institution in a related social justice field.
  1. Are you connected with the National Juvenile Justice Network member in your state? (For a complete listing of NJJN members, visit

__ Yes

__ No

__ Don’t know

If applicable, please describe your connection:

  1. Are you able to commit to attending the Institute’s two in-person sessions in September and in March or April? (Note that the Institute will provide transportation to and from each in-person session as well as room and board.)

__ Yes

__ No

__ Not sure

If not, please explain:

  1. Explain how you will manage the rigors of the Institute’s requirements with your other work and personal obligations.

1319 F St. NW, Suite 402 • Washington, DC 20004 • 202-467-0864 • •

National Juvenile Justice Network | 1

  1. Describe your advocacy project. In crafting your description, please refer to the required components of the advocacy project, found in the Institute FAQ. Your answer to this item may exceed two paragraphs. At a minimum, your description must include the following:
  2. Title
  3. Goal
  4. Strategies
  5. A brief one-year timeline
  6. How you believe this work can be built upon once the Institute year is complete
  1. Is your resume attached?

__ Yes

__ No

  1. Based on the sliding scale, what do you expect your tuition amount to be? $______

Will you require a scholarship?

__ Yes

__ No

Please provide the names and contact information for two nominators who can speak to your experience as an advocate to transform the juvenile justice system, and/or your advocacy efforts in a related field. Each nominator must complete the separate nomination form and submit it directly to NJJN.

Nominator #1

Name:

Organization: ______

Mailing Address:

Phone:

E-mail:

1319 F St. NW, Suite 402 • Washington, DC 20004 • 202-467-0864 • •

National Juvenile Justice Network | 1

Nominator #2

Name:

Organization: ______

Mailing Address:

Phone:

E-mail:

Please provide the name of the organization with which you will be affiliated, the name of a contact person, and contact information.

Organization:

Mailing Address:

Contact Person: Phone:

Email:

The Youth Justice Leadership Institute is supported by generous grants from the Public Welfare Foundation, Herb Block Foundation, Tow Foundation, Annie E. Casey Foundationand the John D. and Catherine T. MacArthur Foundation.

1319 F St. NW, Suite 402 • Washington, DC 20004 • 202-467-0864 • •