Advocacy Academy Application Nov/Dec 2023 (FY24)

This is a 5-day virtual training on Zoom. Nov 28, 29; Dec 6, 7, 15. 1-4 PM ET. The application deadline is Nov 20. We will try to notify you within a week if you are accepted into the program. Thank you for applying!

NOTE to CPE survey designer: If copying this survey for or next year's application survey (ie FY25), move all contact info into one question like our other surveys do so that you can download all contact info at once.

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* 1. Name

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* 2. Best email address for communication, CE certificate, and Zoom links

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* 3. Best Phone Number

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* 4. Job Title

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* 5. Agency Name

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* 6. Kentucky county you work in

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* 7. My APSS certification is current with DBHDID

Yes

Other (please specify)

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* 8. I am currently working in Kentucky as an Adult Peer Support Specialist

Yes

Other (please specify)

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* 9. How did you hear about/become interested in Advocacy Academy?

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* 10. What issues are you inspired to advocate for that relate to your organization's mission?

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* 11. This 5-day virtual training will be interactive. Do you have access to Zoom on a laptop or desktop in a private, quiet location where you can be on camera and audio during the training (may use headphones in shared space)?

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* 12. Are you available and can you commit to all 5 days of the virtual training: November 28 and 29; December 6, 7, and 15, 2023 from 1-4PM ET?

(Note: You should also plan on 1-2 hours of pre-work to collect materials and ensure you can access and use Zoom and the Miro whiteboard. Tech support will be available as needed.)

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* 13. I have permission from my supervisor to participate in the five (5) day program.

Yes

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* 14. My supervisor's name is:

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* 15. My supervisor's email address is:

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* 16. Additional Comments:

Thank you for your application. If you have any additional questions please email Susan Turner at sturner@bridgehaven.org