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Advocacy Camp

October 19th– 21st2011

Rainbow Lodge in North Bend, WA

Application

General Information about Advocacy Camp

Advocacy Camp is a great opportunity to learn and improve leadership ability in advocating for children in public policy. At the end of Advocacy Camp, each graduate willgain tools in lobbying, grassroots community building, and media strategies to make improvements in state policy investments.

Advocacy Camp participants are expected to attend the full training.Tuition is $400 for non-members and $300 for organizational members of the Children’s Alliance.Scholarships are available. We encourage you to apply as soon as possible. Applications are due by Monday, September 12, 2011.

Advocacy Camp is limited to Washington State adult residents.In order to attend Advocacy Camp, you must be an online member of the Children’s Alliance. It’s free to sign up at: We will notify you if you have been selected for Advocacy Camp the week of Monday, September 26, 2011.

We want advocacy campers to reflect the diversity within the child advocacy community. We will be considering geographic, policy issue, socioeconomic, and race/ethnic backgrounds as we review applications. We highly encourage parents/guardians of children directly affected by Children’s Alliance policy issues to apply.We encourage applicants to join with others and apply as a group.We want advocacy campers committed to advocating for policies that benefit children.

This application is also available at: Please return application materials to Emijah Smith, Children’s Alliance, 718 Sixth Avenue So., Seattle,Washington98104, fax: 206-325-6291, or email . If you have questions,please email or call Emijah Smith at 800.854.KIDS x25.

Tell us about yourself (please type or write legibly)

Name / Organization(if applicable)
Address
(city, state, and zip code)
Email: / Phone
Alt. phone
State Legislative District:
Find your district: / County
Are you an online member of the Children’s Alliance?
If not, please sign up now (it’s free!) at /  Yes  No
Are you an organizational member of the Children’s Alliance?
If so, please tell us the name of the organization.
For membership information go to: /  Yes  No
Are you applying with a group of applicants?
If so, please share names of other applicants from the group: /  Yes  No

Optional

Race/Ethnic background:
Gender:
Parent/Guardian of young children? /  Yes  No
Are your kids currently or previously enrolled in any state medical health program? /  Yes  No
Do you work or volunteer with an immigrant community? /  Yes  No
Foster care alumni? /  Yes  No
Are you currently or previously enrolled in the summer meals, food stamps, and/or WIC (women, infants, and children)programs? /  Yes  No
Family income below 200% of the federal poverty level?
($44,700 per year for a family of four) Family income chart: /  Yes  No
How did you find out about Advocacy Camp? / Online, community member, flyer, email, other

Words I live by (response may be shared with other Advocacy Campers): ______

Do you require any special accommodations?

Do you require language interpretation?  Yes  No
If so, please specify the language:
Do you require special meal arrangements?  Yes  No
If so, please check the appropriate box below:  Vegan  Vegetarian  Other (please describe)
Please specify any other requirements:______

Tell us about your policy interests

The Children’s Alliance has three multi-year campaigns. What public policy issue(s) will you work on in the next year? Please select and rank your top two (2)choices of interests:(Ranking 1 is the highest interest.)

___ Children’sHealth
Health Coverage for All
___ Childhood Hunger Nutrition
Access to Healthy Food / ___ Racial Equity
Children of color disparities
___ Early Learning Education
Birth to Pre-Kindergarten / ____ OtherChildren’s Issue
(please specify)

Tell us about your advocacy experience

Have you ever? (check all that apply)
 Been to the state capitol in Olympia?
 Contacted or visited an elected official?
 Played a leadership role in legislative awareness? / Do you know? (check all that apply)
 How to influence the state legislative process?
 How a bill becomes a law?
 How to get your message in the media?

Advocacy Camp Costs

Tuition is $400 for non-members and $300 for Children’s Alliance organizational members. Scholarships are available. Tuition covers all training costs and materials, all meals, and lodging.You will be billed once you are accepted into Advocacy Camp. If someone else is paying your tuition, please write his or her name, phone number, and email address here:

______

Advocacy Camp Schedule

Advocacy Camp participants are expected to attend the full training.Will you be able to attend the entire training, from Wednesday, October 19th at 9:00am to Friday, October 21st at 5:00pm?

Yes, I can attend the entire training.

No, I cannot attend the entire training. Please explain: ______

______

Tell us about your advocacy plans

In 400 words or less please tell us why you want to come to Advocacy Camp? How do you plan to use your Advocacy Camp experience to benefit children in Washington State? What areas would you like to develop yourself as a leader?Do you have a personal connection to the issues the Children’s Alliance works on?

Please attach an additional sheet if needed.

Advocacy Camp is a project of The Children’s Alliance.

718 Sixth Avenue South  Seattle, Washington 98104  206.324.0340  fax 206.325.6291 

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Advocacy Camp

October 19th– 21st 2011

Rainbow Lodge in North Bend, WA

Tuition Scholarship

Scholarship Information

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To request a scholarship, please return this form along with your completed application to: Emijah Smith, Children’s Alliance, 718 Sixth Avenue South, Seattle, Washington 98104, fax: 206.325.6291, or email form isdue by Monday, September 12, 2011. If you have questions, please contact Emijah Smithby email or call 800.854.KIDS x25.We will notify you of decisions regarding Advocacy Camp and scholarships the week of Monday, September 26, 2011.

Scholarship Criteria

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Scholarships are available, as funding permits, to assist low-income participants in attending Advocacy Camp.Applicants with family income below 200% of the federal poverty level($44,700 per year for a family of four)are eligible.Family income chart:

1. Is your family income at or below 200% of the federal poverty level?  Yes  No

2. Will you need financial aid in order to attend Advocacy Camp?  Yes  No

  1. I or my organization can afford to contribute $______toward my advocacy camp tuition.

(Minimum = $50.00)

Transportation Assistance

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We hope to provide transportation stipends to cover mileage costs from selected areas in Washington. If you would like a transportation stipend, please complete and include the transportation assistance application. Would you like transportation assistance?

 Yes  No

Child Care Assistance

While no child care will be provided on-site at camp, we hope to provide financial assistance to help coverchild care costs at home. If you would like a child care stipend, please complete and include the child care assistance application. Would you like child care assistance?

 Yes  No

Acceptance to Advocacy Camp is based on the strength of your application and unrelated to need for tuition scholarships or financial assistance for child care and/or transportation assistance.

Advocacy Camp is a project of The Children’s Alliance.

718 Sixth Avenue South  Seattle, Washington 98104  206.324.0340  fax 206.325.6291 

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Advocacy Camp

October 19th– 21st 2011

Rainbow Lodge in North Bend, WA

Child Care & Transportation

General Policy

The Children’s Alliance is able to offer financial support to advocacy campers who need assistance covering the costs of child care and transportation. The level of assistance depends on need and funds available. While we will do our best to meet your need, we may only be able to provide partial assistance. Acceptance to camp is unrelated to need for scholarships or childcare and transportation assistance.

To apply for assistance, please complete this form and return, with your Advocacy Camp application, to: Emijah Smith, Children’s Alliance, 718 Sixth Avenue South, Seattle, Washington 98104, fax: 206.325.6291, or email at . This form is due by Monday, September 12, 2011. If you have questions, please contact Emijah Smith by email or phone 800.854.KIDS x25.

We will notify you of decisions regarding Advocacy Camp and the amount of assistance we can providethe week of Monday, September 26, 2011.

Your name: Date:

Child Care

I am requesting assistance for child care for: (check one)

One child
Two children
Three children
Four or more children / Before and after school care only
Day only (6 am – 6 pm)
Night only (6 pm – 6 am)
Both Day and Night

How many days and/or nights? ______

How much financial assistance are you requesting? $______

Transportation

I am requesting assistance for transportation: (check one)

$.51/mile for drivers, total miles round-trip ______

Please verify travel by sending a copy of mileage with MapQuest and/or Google Maps documentation.

Up to $200 if you take a bus, plane, or other method(selected areas in Washington).

Advocacy Camp is a project of The Children’s Alliance.

718 Sixth Avenue South  Seattle, Washington 98104  206.324.0340  fax 206.325.6291 

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