You are on page 1of 2

JULY 10 - JULY 16 DETROIT MICHIGAN

2011

The application with essay answers must be received by 5pm February 1, 2011*. It can be faxed, mailed, or emailed using the info provided and is available online at www.c2ea.org. You will be notified of your acceptance by March 1, 2011. If mailing your application, it must be sent a few days earlier to assure it arrives by February 1, 2011. The Youth ACTION Institute is open to non- U.S. residents.

CAMPAIGN TO END AIDS/YAI 2011 727 15th Street NW Suite #210 Washington, DC 20005
Or fax to 202.408.1142.

For more information, please contact: Kennda ‘Kail’ Burt - kali@c2eayouth.com Tony Ray - tony@c2eayouth.com Carrie Rheingans - carrie@c2eayouth.com *International applicants must submit by February 1, 2011, Contact C2EA Youth at info@c2eayouth.com and notified of acceptance March 1, 2011. or 1877 END AIDS (363-2437). Travel arrangements will be made once acceptance is confirmed.
To be completed by sponsoring organization(s):
ORGANIZATION NAME CONTACT PERSON/TITLE

ADDRESS

By signing below I agree that my organization will sponsor and support this applicant with fundraising and completion of the post-YAI project .
CONTACT SIGNATURE

PHONE

DATE

Your Contact Information
NAME

Emergency Contact Information
NAME

PERMANENT ADDRESS

RELATIONSHIP

PERMANENT ADDRESS

ALTERNATE ADDRESS

HOME PHONE

WORK PHONE

E-MAIL HOME PHONE WORK PHONE

E-MAIL

Dietary/Other Requirements
FOOD REQUIREMENTS / DIETARY RESTRICTIONS

Background Information
AGE GENDER OTHER REQUIREMENTS (Male) (Female) (M2F) (F2M)

(Optional)
HIV STATUS RACE/ETHNICITY

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it
Parent/Guardian (required if under 18)
PRINTED NAME

are true and complete.
PRINTED NAME

SIGNATURE

DATE

SIGNATURE

DATE

1

JULY 10 - JULY 16 DETROIT MICHIGAN

2011

The application with essay answers must be received by 5pm The application with essay answers must be received by 5pm on February 1, 2011*. It can be faxed, mailed, or emailed using the info provided and is available online at www.c2ea.org. You will be notified of your acceptance by March 1, 2011. If mailing your application, it must be sent a few days earlier to assure it arrives by February 1, 2011. The Youth ACTION Institute is open to non- U.S. residents. *International applicants must submit by February 1, 2011. and notified of acceptance March 1, 2011.

CAMPAIGN TO END AIDS/YAI 2011 727 15th Street NW Suite #210 Washington, DC 20005
Or fax to 202.408.1142. For more information, please contact: Kennda ‘Kali’ Burt - kali@c2eayouth.com Tony Ray - tony@c2eayouth.com Carrie Rheingans - carrie@c2eayouth.com Contact C2EA Youth at info@c2eayouth.com or 1877 END AIDS (363-2437).

Pre-Conference Fundraising Pre-Conference Fundraising
All applicants that are invited to attend thethe conference are requiredto raise $600 to help defer costs. This is is also good way for for participants All applicants that are invited to attend conference are required to raise help defer costs. This also a a good way to get participants to get intoand get a feel for the obstacles the obstacles and possible setbacks occur when planning planning their project. into the community the community and get a feel for and possible setbacks that might that might occur when their summer summer project.

Post-Conference Project Post-Conference Project

As a participant you will be asked to partner with an AIDS Service Organization (ASO), community-based organization, religious institution, youth group, LGBTQ group, school or to partner with an AIDS Service Organization (ASO), project that will be carried out religioussummer 2009 and As a participant you will be asked other entity to carry out a grassroots organizing community-based organization, during may be continued after. Organizing projects should other entity to carry outissues, C2EAorganizing project that will be carried out institution, youth group, LGBTQ group, school or be link youth priority a grassroots demands (treatment, research, prevention & respect), pressing local needs 2010development of grassroots Organizing projects should link youth priority develop a project that is particularly relevant to during summer and and may be continued after. networks. We encourage participants to issues, C2EA demands (treatment, your community surrounding HIV/AIDS. research, prevention & respect), pressing local needs and development of grassroots networks. We encourage participants to develop a project that is particularly relevant to your community surrounding HIV/AIDS. In particular thin about the following questions: In particular think about the following questions: 1. How is HIV/AIDS affecting you and your peers? 2. 1. What is your school or local government doing HIV & AIDS affect you and your peers? What do you about HIV & AIDS? How does about it? 3. 2. What changes would youor local see in your local community? What is your school like to government doing about it? 4. 3. What gaps in services can you like to see in yourcommunity? What changes would you identify in your local community? 4. What gaps in services can you identify in your community?

Essay Questions (use separate sheet of paper for answers) Essay Questions (use separate sheet of paper for answers)

Please answer each of the following questions as completely and accurately as possible. Please answer each of the following questions as completely and accurately as possible. 1. When did you first realize HIV/AIDS was something people fight against? What were the implications to you? (1-2 Paragraphs) 2. 1. What is yourdid you first realize HIV & AIDS wasor work- related) with HIV/AIDS and were the implications to in any advocacy or activism When experience (personal, volunteer, something people fight against? What have you participated you? around the issue? (1-2 Paragraphs) 3. 2. What skills or your experience (personal, volunteer, by work- related) with HIV & AIDS and have you participatedmost useful to you organizing What is knowledge are you hoping to gain or attending the Youth Action Institute? What would be in any around HIV/AIDS in your community?issue? What does activism and advocacy mean to you? advocacy or activism around the (1-2 Paragraphs) 4. 3. Please outline a summer project you will be committed to carrying Youth Action Institute? What would be most useful to Include names What skills or knowledge are you hoping to gain by attending the out for at least two (2) months after the conference. of organizations you around HIV & AIDS in your community? (1-2 Paragraphs) you organizing plan to partner with, fundraising plans, and overall goals for your project. 5. 4. Are you committed tosummer project you will be committed to carryingAIDS post conference? To what capacity? Please outline a continuing the work of the Campaign to End out for at least two (2) months after the conference. Include names of organizations you plan to partner with, fundraising plans, and overall goals for your project. 5. Are you committed to continuing the work of the Campaign to End AIDS post conference? To what capacity?

For more information, contact C2EA Youth at info@c2eayouth.com or 1877 END AIDS (363.2437).

2