Jump Start a Local Collaboration for Youth (LCY)

Application Form

Complete this brief application and submit to Suzanne Hershey at by 6 p.m. ET on Monday, April 30, 2012.

Applicant Community: ______

If this community is not a city (e.g. a county, region, etc.), please tell us the largest city or town(s) in your defined community:

Please provide brief but specific responses to the following questions (150 words or fewer per answer):

Why do you want to participate in this project? What purpose would a Local Collaboration for Youth serve in your community? What need(s) would it address?

What do you have to start with or build upon to create your cross-cutting Local Collaboration?

What are your planning team’s initial thoughts about activities or shared work in your community that this new or expanded collaboration may explore or undertake during the Jump Start project period?

Terms of Partnership:

We agree to the following:

We have identified at least five representatives of different organizations for a planning team (includingat least three National Collaboration for Youth affiliates) who agree on behalf of our organizations to launch the collaboration during the project period and engage partners to develop it going forward.
At least one organization on the planning team commits to convene and provide staff support for meetings during the project period. (The Point of Contact and convener may be the same individual/organization.)
This community does not already have a broad, cross-cutting partnership of youth service provider organizations working across age groups and issues.

If selected to participate in the Jump Start project:

The Point of Contact and at least one other member of the planning team will attend an introductory webinar in May 2012.
A planning team representative will participate in a one-day cross-site meeting for Jump Start in Washington, D.C., during September 2012. (Travel expenses will be covered by the project.)
The Point of Contact, on behalf of the planning team, will submit a brief project report by Sept. 30 outlining project status, accomplishments, lessons learned, and any plans to develop the collaboration going forward.

Signature

Point of Contact: ______Date: ______

Planning team members
(please complete requested information) / NCY affiliate?
Point of Contact / Name :
Organization:
Job Title:
Phone:
Email:
Meeting convener/provide staff support / Name :
Organization:
Job Title:
Phone:
Email:
Name :
Organization:
Job Title:
Phone:
Email:
Name :
Organization:
Job Title:
Phone:
Email:
Name :
Organization:
Job Title:
Phone:
Email:
<Please add additional rows for any additional planning team members.>

For information about Ready by 21 and the Forum for Youth Investment, visit and

For information about the National Collaboration for Youth, visit .