Delegate Leader Application, 2012

8420 Delmar Blvd, Suite 500 St. Louis, Missouri 63124-2180 Tel (314) 432-2525 Fax (314) 432-2526 Website: www.nccjstl.org Email: programs@nccjstl.org

Anytown Youth Leadership Institute

INFORMATION:
What is the Anytown Youth Leadership Institute? The Anytown Youth Leadership Institute, a program of The National Conference for Community and Justice of Metropolitan St. Louis (NCCJSTL), is a unique residential program for high school age youth. Anytowns goal is to prepare youth to be more effective leaders and change agents who are dedicated to fighting bias, bigotry, and oppression. Youth participate in experiential learning activities and dialogue sessions designed to increase their understanding of human relations issues and of their own responsibility to create a community based on inclusion, trust, and mutual respect. The National Conference for Community and Justice of Metropolitan St. Louis is a human relations organization dedicated to fighting bias, bigotry and racism in America. NCCJSTL promotes understanding and respect among all races, religions and cultures through advocacy, conflict resolution and education. When will this years Institute take place? There are two Anytown sessions this summer. The first Institute will be June 24-July 1 and the second Institute from July 22-29. Anytown Delegate Leaders are expected to be on site two days prior to the beginning of the Institute. Delegate Leaders for the first session are required to be on site June 22-July 1. Session two Delegate Leaders are required to be on site from July 20-29. What do Delegate Leaders do? Delegate Leaders have three primary responsibilities. Delegate Leaders should engage with the Anytown curriculum as a participant, taking the opportunity to continue their individual social justice journey. They will also be expected to assist with program components throughout the Anytown Institute. The final role, and one of most importance, is to model Institute guidelines and community norms, while mentoring first time delegates. For a full description of the roles and responsibilities of Delegate Leaders, please see Part 3 of this application. Is there training for Delegate Leaders? Yes. Delegate Leaders will be expected to attend one and a half days of staff training during the weekend of June 8-10. Delegate Leaders are also required to report to the training site two days prior to delegates. ATTENDANCE AT ALL TRAINING SESSIONS IS MANDATORY unless permission is granted by the Program Director. Are Delegate Leaders paid? Delegate Leaders receive a stipend for the Institute of $200. As part of Anytown Youth Leadership Institute, Delegate Leaders will receive an invaluable and rewarding opportunity to impact the lives of youth in the St. Louis Region, and a chance to experience Anytown again, valued at $1,250. All Institute expenses (lodging, food and mileage) are paid for by NCCJSTL. How many participants will be attending? Approximately 35-45 participants attend each Anytown session. Participants are supported throughout the week by a group of 15-17 Delegate Leaders and Facilitrainers, allowing for a low participant to staff ratio. What about the Institute facility, housing and meals? The Anytown Institute will be held on the South Campus of the University of Missouri St. Louis. All sleeping spaces are air-conditioned, as are all meeting spaces. Meals are served three times a day and snacks and water are available throughout the day. Anytown Faculty will handle basic medical needs. Medical emergencies are handled by a nearby hospital. Who can apply to be a Delegate Leader? Generally, only those who have attended Anytown as a delegate qualify to serve as a Delegate Leader. NCCJSTL encourages people of all racial, religious, ethnic, gender, sexual orientation, class, cultural, physical ability, and other
Anytown Delegate Leader Application The National Conference for Community and Justice of Metropolitan St. Louis www.nccjstl.org 314-432-2525, programs@nccjstl.org.

identity groups to apply. How do I apply? Please complete the enclosed application. There are 6 sections in this application. Please make sure all sections are completed. If you are younger than 18 years of age, you must have a parent or legal guardian sign section 6. Once all sections are complete, make a copy of the application for your own records and return the application to the NCCJSTL office by mail, fax (see below), or by e-mail at programs@nccjstl.org. NCCJSTL, Anytown Youth Leadership Institute 8420 Delmar Blvd. Ste. 500 St. Louis, Missouri 63124-2180 Or Fax it to (314) 432-2526 Applications are due on March 12, 2012 How will I know if Im accepted? Following the application deadline, NCCJSTL staff will contact you to discuss your application. Qualifying applications will do an interview with program staff. If you are unable to attend an in-person interview, you will be required to do a phone or Skype interview. Once final staffing decisions have been made by mid April, you will be notified of the results. Please call or email David Martineau or Emily Jones to make sure that your application has been received.

(Please keep pages 2-3 for your records)

Anytown Delegate Leader Application The National Conference for Community and Justice of Metropolitan St. Louis www.nccjstl.org 314-432-2525, programs@nccjstl.org.

Delegate Leader Application: Part 1

Instructions:
To be completed by applicant by printing or typing in responses. Fill out requested information completely. If you do not know, write unknown. Session I Session II June 22-July 1, 2012 July 20-29, 2012 University of Missouri-St. Louis University of Missouri-St. Louis St. Louis, MO St. Louis, MO I am applying for the first session I am applying for the second session I can staff either session I can staff both sessions Legal First Name Last Name____ *All mail and non-legal documents will use this name unless you request otherwise Home Address City State Zip Preferred Name*____ (If different from legal name/not a nickname)

Home Phone

Cell Phone

School/Employer Address City

State

Zip

Work Phone Date of Birth

Fax Age

Grade (If applies)

SS # Email ___ Which address do you prefer to receive correspondence from NCCJSTL? Home Employer School T-Shirt size (please check one) Small XXX-Large Medium Large Other ________ X-Large XX-Large

After Anytown, a telephone/address/e-mail list will be distributed to all participants and faculty. Please check this if there are parts of your contact information that you want to be left off the roster. Please list what you would like to appear on the rosters, (faculty roster and participant roster) on the lines below.
Anytown Delegate Leader Application The National Conference for Community and Justice of Metropolitan St. Louis www.nccjstl.org 314-432-2525, programs@nccjstl.org.

Delegate Leader Application: Part 2

Demographic Information
Instructions:
The information in this section is used to ensure that we have as diverse a staff at Anytown as possible. Only NCCJSTL staff will see this information. Please check all boxes that apply. 1) 2) Gender Identity: Man Please check all boxes that apply Transgender/Gender Variant Woman Other

Racial / Ethnic Background: Please check all boxes that apply American Indian / Native American Asian / Asian American Bi-Racial / Multi-Racial (please specify) Black / African American Jewish Latino (a) / Hispanic / Chicano (a) Middle Eastern Pacific Islander South Asian White / Caucasian / European American International (please specify) Other (please specify) ____ Sex: Female Please check all boxes that apply Intersex Male Transsexual Other Lesbian

3) 4)

Sexual Orientation: Please check all boxes that apply Bisexual Gay Heterosexual Pansexual Queer Questioning Other (please specify)

5)

Socioeconomic Class: Please check the one that most closely reflects your current status: Lower/working Class Lower Middle Class Middle Class Upper Middle Class Upper Class

6)

Religious Affiliation: Atheist Baha'i Deist Eckankar Native American Protestant Christian Spiritualist Taoist Wiccan/Pagan/Druid

Buddhism Hinduism New Age Scientology Unitarian Universalist Other

Catholic Christian Islam Judaism Nonreligious Secular/Agnostic Sikhism

Please use the following space to tell us any additional information about your identity that you would like to share: (For example physical ability, immigrant status, etc.) ___

Anytown Delegate Leader Application The National Conference for Community and Justice of Metropolitan St. Louis www.nccjstl.org 314-432-2525, programs@nccjstl.org.

Delegate Leader Application: Part 3

Roles and Responsibilities Description
Anytown is staffed by Delegate Leaders and Facilitrainers. Facilitrainers will be paired with Delegate Leaders to implement parts of the programming throughout the Institute. Both roles bring a crucial skill set that is imperative for the success of the Anytown Youth Leadership Institute. If you are interested in applying for a Facilitrainer position, please fill out the Facilitrainer Anytown 2012 application. Delegate Leaders: Delegate Leaders are graduates of Anytown. This position allows alumni the opportunity to return to Anytown, further their own critical thinking and leadership skills, and contribute to the lifelong learning of others on social justice issues. Delegate Leaders assist facilitrainers and program staff with certain parts of the Anytown program. Delegate Leaders receive training prior to Anytown for their role and a stipend of $200 for their contribution to the Institute. Delegate Leaders responsibilities are as follows:

Model community norms and Institute guidelines for first time Anytown delegates Encourage and engage first time Anytown delegates in following Institute norms and guidelines Continue ones own social justice journey by participating in Anytown curriculum components Serve as a mentor to Anytown delegates in processing their experience of the Anytown curriculum Assist with elements of the Anytown program (for example: Table Groups, Organized Fun Time, and some curriculum elements) Support Anytown faculty in carrying out duties needed to create a safe and productive Anytown environment Attend and participate in required training Openly communicate first time Anytown delegates needs with program faculty Help first time delegates trust the process of Anytown in an effort to ensure their Anytown experience is as powerful as yours was Other duties as they arise during Anytown

Anytown Delegate Leader Application The National Conference for Community and Justice of Metropolitan St. Louis www.nccjstl.org 314-432-2525, programs@nccjstl.org.

Delegate Leader Application: Part 4

Staff Questions
Please put your answers under each question if doing this electronically. Use an additional sheet if printing this to mail or fax.
1. What year did you attend Anytown? How have you been involved in anti-oppression work since your Anytown experience and how has Anytown helped shape this work?

2.

What personal learning goals would you like to accomplish at this years Anytown as a Delegate Leader?

3.

What particular insights, personal passion, beliefs, or values about dismantling oppression do you bring to this work?

4.

What specific qualifications, strengths, or insights would you bring to the position?

5.

Why do you want to attend Anytown again?

6.

What challenges do you foresee returning to Anytown in a new role? How do you anticipate overcoming those challenges?

Anytown Delegate Leader Application The National Conference for Community and Justice of Metropolitan St. Louis www.nccjstl.org 314-432-2525, programs@nccjstl.org.

Delegate Leader Application:

Part 5

Statement of Philosophy
NCCJSTLs Anytown Youth Leadership Institute is guided by the following philosophical principles. Your signature below means that you have read and understand our philosophy and that you can implement the Anytown program in accordance with these principles.

1.

NCCJSTLs work covers all forms of discrimination and oppression. However, the Anytown Youth Leadership Institute focuses on the multiple manifestations of discrimination and oppression that are based on ones gender, sex, sexual orientation, socio-economic class, and race (i.e. sexism, genderism, heterosexism, classism, and racism) and the relationship between these identities and forms of oppression. NCCJSTL believes that there is no hierarchy of oppression; no one issue or identity is more important than another. No form of oppression can be dismantled until all forms of oppression are dismantled. NCCJSTL believes that in order to promote understanding and respect across groups and to dismantle oppression, we must acknowledge the dynamics of power and privilege and the role they play in creating attitudes, behavior, and practices that support systems of exclusion and oppression. NCCJSTL believes that all members of society at some time may feel the impact of systemic oppression, overt or covert, intentional or unintentional, conscious or unconscious. NCCJSTLs work is about issues, not about guilt or blame. Age issues on staff occur and need to be processed. Everyone needs to exercise his/her/hir authority to speak and be recognized. Upper and middle class white male able-bodied heterosexuals are not the enemy. Be aware of the inherent need to have a scapegoat. You do not have to be a member of a targeted or a privileged group to work with that group. You may at times be called upon to work with a group outside your own life experience and we ask that you be aware of how your issues, and/or their issues may show up.

2.

3. 4. 5. 6. 7.

DO NOT SIGN UNLESS FULLY UNDERSTOOD

________ Applicant Signature

____ Date

Anytown Delegate Leader Application The National Conference for Community and Justice of Metropolitan St. Louis www.nccjstl.org 314-432-2525, programs@nccjstl.org.

Delegate Leader Application: Part 6

Consent Form/Waiver
Instructions: Please read and sign, if under 18, make sure both applicant and parent or guardian sign. If either signature is missing, the application will be returned.
1. I understand that the Anytown Youth Leadership Institute is an intensive human relations workshop that deals with mature subject matters. I understand that workshop topics will include values clarification, selfesteem, stereotypes and prejudice, interpersonal communication, racial identity, racism, sexism, genderism, heterosexism, classism, family issues, institutional and personal power, and more. I understand that Institute participants and staff often find it to be an emotional experience. Throughout the week, participants and faculty may experience confusion, anger, joy, sadness, frustration, hope and more as they learn. I assure you that I (my child) have no known mental or emotional disorders or sensitivities which would interfere with my (my childs) participation and that I (my child) am capable of handling the subject matter and emotional nature of this program. I understand that although NCCJSTL has taken precautions to provide proper organization, supervision, instruction, and equipment for each activity, it is impossible for NCCJSTL to guarantee absolute safety. I also understand that each participant shares the responsibility for safety during all activities and I assume that responsibility for myself (for my child). I waive any claim that may arise against the Board of Directors of the NCCJSTL, Inc. and/or its employees, agents, lessors, volunteers, or lessors including those claims that may arise from the negligence of NCCJSTL, Inc.; its Board of Directors; and/or its employees, agents, lessors or volunteers. If the Program Director must send me (my child) home for any reason, I agree to leave immediately (pick up my child within four hours of the Program Directors call) - unless other arrangements are made with the Program Director. For parents/guardians: I understand that I may be called at any time of the night or day to arrange for my childs transportation home and that I will be responsible for all costs associated with such transportation. I have read and understand all the enclosed documents in this packet.

2.

3.

4.

5.

DO NOT SIGN UNLESS READ AND FULLY UNDERSTOOD Applicant Signature _____Date ______ Parent / Guardian Signature _____Date _____

Anytown Delegate Leader Application The National Conference for Community and Justice of Metropolitan St. Louis www.nccjstl.org 314-432-2525, programs@nccjstl.org.

Application Checklist
Signatures: There are 2 signatures required to complete this application and an additional 1 from a parent / guardian if applicant is under 18. (Signatures will be required on a hard copy upon acceptance if you are submitting this electronically.) Please keep a photocopy of your completed application for your own records! If you have questions about the application or application process, call David Martineau or Emily Jones at (314) 432-2525.

IMPORTANT NOTE:
There are many factors that go into the selection of Anytown staff. Among them is your availability to work an Institute session, the identities that you hold, as well as the number of applicants that apply with your same identities, and your experience with anti-oppression work both in and outside of Anytown. It is important to remember that we receive many more applications than there are staff positions available, so please apply again for a future Anytown staff position if for any reason you are not a part of the 2012 staff.

Please return this application as soon as possible.

You are welcome to email, fax, or mail your application to any of the following locations: Email: programs@nccjstl.org Fax: (314) 432-2526 Mail: NCCJSTL, Anytown Youth Leadership Institute 8420 Delmar Blvd. Ste. 500 St. Louis, MO 63124-2180

Anytown Delegate Leader Application The National Conference for Community and Justice of Metropolitan St. Louis www.nccjstl.org 314-432-2525, programs@nccjstl.org.

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