GA First 2000 Days Champion Agreement

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Please complete this form to commit to serving as a First 2000 Days Champion in Georgia. Champions play key roles in community outreach. They are trained to give the First 2000 Days presentation, suggest opportunities to give presentations and are presenters themselves. These community influencers carry the First 2000 Days message with them in their professional and personal life.

Please contact Meagan Jackson at GEEARS with any questions (mjackson@geears.org)

Georgia First 2000 Days

First and Last Name *

Email Address *

Mailing Address (where your toolkit will be shipped) *

Phone Number *

Title and Organization/Company

Professional or Volunteer Organization Affiliations *

How did you hear about the campaign? *

I believe the first 2,000 days of a child's life are important because... (short paragraph response) *

I am committed to participating as a Champion in the following ways: (check the items your organization can commit to) *

Submitting a Photo + quote or video clip about the importance of the first 2,000 days of a child’s life that will be shared online or in print.

Sharing campaign updates via email, social media, and in person

Presenting the First 2000 Days PowerPoint and/or Video to business, organization, or community groups

Committing to engage in informal conversations with your network about the First 2000 Days campaign

Encourage those in your network to donate to early childhood efforts

Wearing my First 2,000 Days lapel pin to events

Donating resources or funding to support early childhood advocacy

Other:

Required

Age Range *

Under 17

18-24

25-35

36-55

56-70

70+

County of Residence *

City of Residence *

Please submit a professional photo that may be shared in First 2000 Days promotional materials to Meagan Jackson at mjackson@geears.org *

I do not want my photo shared

Submit

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