National Juvenile Justice Network | 1

Youth Justice Leadership Institute

Building a Movement

Organizational Affiliation Form 2018

Thank you for engaging with the Youth Justice Leadership Institute. The Institute’s mission is to create the foundation for a more effective juvenile justice reform movement by developing a strong base of advocates and organizers from communities of color – those most affected by juvenile justice practices -- who are engaged in the work of reforming juvenile justice systems. (Go to for more information.)

Your organization will serve as a “home” during the year for the fellow, providing in-kind support for the fellow’s involvement in the Institute.Your support may include work space, access to technology and office equipment, access to staff or volunteer development resources, and resources for information on reform efforts. The organizational affiliate must also be available to work with Institute staff to assist the fellow in completing the program requirements.The fellow need not be an employee of the organization, although we find that an employer/employee relationship is often the most productive for the Institute.Nevertheless, serving as the organizational affiliate only requires a willingness to support and involve the fellow as fully as the organization's available resources will allow.

Please complete all fields and questions below.You are not limited to the space provided, but please be concise. This form must be submitted no later than 11:59PM Eastern time,April 23, 2018, or the applicant will not be considered for selection.The signers of these forms may be required to have a brief conversation with Institute staff before a final invitation to be a fellow is extended to an applicant.

Please complete and return a copy of this form, by email, to:

Diana Onley-Campbell

Youth Justice Leadership Institute Coordinator

National Juvenile Justice Network

Please direct any questions or concerns to Dianavia emailat .

Applicant’s Name:

Organization:

Mailing Address:

Contact Person:Position:

Email: Phone:

If the fellow is an employee of the organization, will he/she be released from work to travel to two Institute sessions, lasting up to 4 days each?

__ Yes__ No__Not an employee

If no, please explain (to help us accurately assess the applicant’s eligibility):

If the fellow is an employee, will the Institute’s requirements (in-person gatherings, distance learning activities,and advocacy project) be considered part of the fellow’s employment responsibilities?

__Yes__No__Not an employee

If no, please explain (to help us accurately assess the applicant’s eligibility):

1424 K Street NW Suite 403• Washington, DC 20005 • •

National Juvenile Justice Network | 1

What supports will the fellow receive from your organization during the year he or she participates inthe Institute?Please answer as specifically as possible.

If the fellow has difficulty meeting the requirements of the Institute, who may we contact to work with Institute staff to get them back on track?

Name and Phone: (if different from above) ______

Signature of Executive Director or CEODate

Print Name of Executive Director or CEODate

Thank you for your support

of the Institute and its applicants!

The Youth Justice Leadership Institute is supported by generous grants from the Andrus Family Fund, Annie E. Casey Foundation, Herb Block Foundation, Public Welfare Foundation, the Robert Sterling Clark Foundation, and the Tow Foundation.

1424 K Street NW Suite 403• Washington, DC 20005 • •