Community Leadership Council Application

Thank you for your interest in applying to our Community Leadership Council.

Our application asks you a series of questions about yourself and your experiences in addition to contact information.

After you submit your application, staff representing the Healthy Minds, Healthy Kids Campaign (at CCC New York, FTNYS, and CBHNY) will review your application. We will make final decisions on your application and let you know within two weeks of your submission


More details about the application and what you may expect if you are a part of the council can be found here: Community Leadership Council Overview

Questions? Contact us via email at crosales@cccnewyork.org
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Email *
First Name *
Middle Name (Optional)
Last Name *
Street Address *
Apartment Number (If Any)
City *
Zip Code *
Gender *
What pronouns do you use?
Date of Birth *
MM
/
DD
/
YYYY
Cell Phone Number

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This will help us reach out to you if we have any questions about your application.
Ways To Contact You
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Required
How would you describe yourself? (select all that apply)
 *
Required
Do you have a laptop/computer and internet access at home?
 *
If accepted, should we connect with you about any impact stipends would make towards your financial considerations?
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For example: a stipend affecting income requirements for a program your are in, a scholarship you get, or a public benefit you are receiving.
How will you be spending most of your time in 2023?

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Select all that apply. For example, if you are working full-time and going to school part-time, or working part-time and doing a GED program, select both of those options.
Required
Are you affiliated or have participated in a program by any of these organizations?
 *
  • The Campaign for Healthy Minds, Healthy Kids
  • Citizens' Committee for Children of New York
  • Families Together in New York State
  • The New York State Coalition for Children's Behavioral Health
Why are you interested in becoming a member of the Community Leadership Council?

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In your opinion, what are two of the biggest challenges facing children and youth as it relates to mental/behavioral health? Why?
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Do you have past experience in advocacy or something you have enjoyed learning about? Tell us about what you did/learned from that process.

What accomplishment are you most proud of? Tell us about it and why is it important to you?
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Tell us about an experience when you worked with a group of other people. What strengths did you bring to the group? What were the challenges of working within the group?

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We understand that people have lots of different feelings about virtual learning and participation. What has the virtual setting been like for you? What have you enjoyed? What has really not worked for you?
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Is there anything else you would like to share with us to consider with your application?
A copy of your responses will be emailed to the address you provided.
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