Camp HOPE America-Arkansas Nomination Form
We’re excited that you’ve chosen to nominate a child to attend Women & Children First's Camp HOPE 2020! Camp HOPE America- Arkansas is the first camping and mentoring initiative in the state to focus on children exposed to domestic violence, sexual assault and/or child abuse. Please answer the questions below so that we can know a bit more about the child you are nominating. Due to limited space, please note that we are not able to guarantee attendance for any child. Campers should be between the ages 7-17. We will be conducting screening interviews in February through May 2020 with children and their parent/guardian before officially offering spots for camp. Thank you for your understanding!
Your Name *
First and last name
Your answer
Your Email *
Your answer
Your Phone Number *
Your answer
What organization do you work for?
Your answer
What is the name of the child you are choosing to nominate?
Your answer
How do you know the child you are nominating? *
Your answer
What services is this child currently receiving (therapy, childcare, etc.)?
Your answer
How long ago did this child experience/witness domestic violence or another form of abuse?
Your answer
Is the child currently in a stable home environment (i.e. was not recently put into foster care, no longer lives with the abusive party, etc.)? If so, please describe.
Your answer
Has this child had the opportunity to process their trauma with a mental health professional? If so, please describe.
Your answer
How have you seen this child handle conflict or not getting their way? How does the child handle conflict?
Your answer
Does the child have any known behavioral issues? If yes, please describe.
Your answer
If this child has had behavioral difficulty in school recently, what has been the nature of that difficulty?
Your answer
What are some potential challenges that might arise if this camper attends Camp HOPE America-Arkansas?
Your answer
What do you believe that this child/family would gain from involvement in Camp HOPE America-Arkansas?
Your answer
Is there anything else that would be helpful for us to know in advance?
Your answer
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