Contact Information:

* 1. Individual Completing Application:

* 2. Chapter or Division Name:

* 3. Chapter or Division President:

* 4. Contact Information

* 5. Number of Members:

* 6. Average Event Attendance:

* 7. Typical Event Locations (Such as, but not limited to: hotels, restaurants, college/universities, homes, etc...)

* 8. Does your Chapter have an Area COO?

* 9. Does your Chapter partner with local NGOs?

10. If yes, please list NGOs:

* 11. Has your Chapter held events at a local college or university?

12. If yes, please list colleges/universities:

* 13. Has your Chapter conducted programing on the current MDGs in the past?

* 14. How will your Chapter identify and invite local NGOs to participate in this discussion?

* 15. How will your Chapter select "topic experts" to lead discussions? (A "topic expert" should be prepared to lead a small group discussion)

* 16. Chapter Consultations will occur between August - November, 2013. Please list the months and/or dates that work best for your Chapter.

* 17. How will an official consultation benefit your Chapter? Your Community?

* 18. We agree to work with a local Save the Children Chapter, a UNA consultant, and other partners identified by UNA to implement this event.

* 19. We guarantee that we will produce an event with at least forty people.

* 20. We agree to provide breakfast, lunch, or another food and beverage opportunity to attendees, paid through this grant funding.

* 21. We will secure a venue in a central location, paid through this grant funding.

* 22. We agree that a consultant from UNA will be present at the event and will facilitate the discussion.

* 23. We agree that all discussion is considered "on the record" and will be included in a final white paper that will be distributed to the UN.

* 24. If a Division, we will include every Chapter within the Division in this event.

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