2022 Garden State Leaders Program Application

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Thank you for your interest in becoming a Garden State Leader. We will follow-up with you after receiving your application, so please be sure to provide a reliable phone number and email address. All contact information and answers are kept confidential. If you have any questions on the application or program, please contact:
Kate Leahy: kleahy@njceh.org

Full Name *

Phone Number *

Email *

Mailing Address

Why would you like to participate in this program? *

Why do you feel it is important to develop advocacy skills? *

How do you hope participation in this program will help you as an advocate? *

Can you commit to participating in a total of 8 sessions, including 4 in-person, day-long sessions (3 to be held at Middlesex College in Edison and one at the State House in Trenton) as well as 4 virtual sessions between the end of June and beginning of October 2022? (We may be able to provide information to employers on the benefits of leadership development training) *

Yes

Do you need assistance with transportation, childcare or other basic needs in order to participate in the program? *

Yes

Other:

If you answered YES above, please tell us specifically what would help to make it possible for you to participate? (e.g. bus fare to and from each session)

Do you have access to a computer or tablet? *

Yes

Do you have access to a reliable internet connection? *

Yes

Do you have experience using Zoom for online meetings? *

Yes

Is there anything else you'd like us to know?

How did you hear about the Garden State Leaders Program? *

Please provide the name and contact information (email and/or phone number) for 1-3 people who know you and can serve as references. Examples of possible references are neighbors, family members, friends, faith leaders, educators, employers, case workers, etc. *

Have you ever communicated with an elected official about an issue you care about? *

Yes

Have you ever experienced poverty or economic hardship in your life? *

Yes

Please answer the following questions: (Note your answers to these questions will not necessarily determine your eligibility for the program, as we understand poverty is a subjective condition. This questionnaire is more to help you understand what are generally considered indicators of poverty and to help us get a sense of our participants' experiences in order to inform program curriculum.)

Have you ever had a full-time job and still struggled to make ends meet?

Yes

Clear selection

Have you ever had to work more than one job to meet your family's basic needs?

Yes

Clear selection

Have you ever received welfare (general assistance, AFDC, or TANF?)

Yes

Clear selection

Have you ever been denied welfare (general assistance, AFDC, or TANF?)

Yes

Clear selection

Have you ever received SNAP (food stamps), WIC, Medicaid or SSI?

Yes

Clear selection

Have you ever been denied SNAP (food stamps), WIC, Medicaid or SSI?

Yes

Clear selection

Have you ever gone to a food pantry to feed yourself or your family?

Yes

Clear selection

Have you or anyone in your immediate family ever lived with a medical condition for which you or they were unable to afford necessary medicines or treatment?

Yes

Clear selection

Have you ever been homeless?

Yes

Clear selection

Have you ever had to stay with friends or family because you could not find an affordable place to live?

Yes

Clear selection

Have you ever missed school or doctor's appointments because you could not find affordable transportation?

Yes

Clear selection

Have you ever been unable to go to the grocery store because you could not find affordable transportation?

Yes

Clear selection

Have you ever had your utilities shut off?

Yes

Clear selection

Have you or any member of your family ever gone without meals because there wasn't enough money for food?

Yes

Clear selection

Have you ever stayed in an abusive relationship because of a lack of economic options?

Yes

Clear selection

Have you ever been unable to afford childcare?

Yes

Clear selection

Have you ever had to leave school or training because you couldn't afford to go anymore?

Yes

Clear selection

Thank you for taking the time to fill out this application and tell us about your experiences. We will be in touch with you soon.

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