Children's Alliance Public Policy Council Application for Membership

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* 1. Name:

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* 2. Your affiliations with organizations, if any:

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* 3. Children’s Alliance Membership Status (check one):

I work for an organization that is an organizational member of Children's Alliance

I am an individual member of Children's Alliance in current standing as defined by the Board of Directors. Financial contributions are optional. Here is how to become an individual member.

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* 4. Mailing Address

Address line 1:

City:

State:

Zip code:

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* 5. Phone number:

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* 6. Email address:

The following questions are asked to help inform the Public Policy Council about the composition of our applicant pool so that we may fulfill our commitment to creating a council that is diverse in various ways.

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* 7. Race/Ethnicity

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* 8. County in which you live/work:

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* 9. Gender (optional):

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* 10. Age:

The following questions are asked to help inform the Public Policy Council about your experience and interests.

Children's Alliance Public Policy Council Application for Membership

Question Title

* 1. Name:

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* 2. Your affiliations with organizations, if any:

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* 3. Children’s Alliance Membership Status (check one):

Question Title

* 4. Mailing Address

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* 5. Phone number:

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* 6. Email address:

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* 7. Race/Ethnicity

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* 8. County in which you live/work:

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* 9. Gender (optional):

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* 10. Age:

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* 11. What experience do you have advancing racial equity in public policy?

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* 12. What children’s issues interest you/concern you the most?

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* 13. What kind of experience do you have with this issue?

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* 14. Please describe any special skills you bring to the Public Policy Council.

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* 15. Please include a short bio that can be shared with Public Policy Council members.