Staten Island My Brother's Keeper (MBK) Convening Session

CALL TO ACTION SURVEY

Thank you for participating in the Staten Island My Brother’s Keeper (MBK) Convening Session, held on [Enter Date]. To facilitate the coordination of our collective efforts toward closing and eliminating the opportunity gaps faced by boys and young men of color so that all our young people have the chance to reach their full potential, we ask that you complete and submit this short survey for your organization, which will aid us in developing a road map for success.

Directions:
In Section I, please provide your organization’s contact information.
In Section II, please indicate which of the activities described your organization can assist with to support achievement of one or more of the following National and New York State My Brother’s Keeper Milestones:

National MBK Milestones
At the national level, MBK is focused on ensuring that all children:

Enter school ready to learn;
Read at grade level by third grade;
Graduate from high school ready for college and career;
Complete postsecondary education or training;
Successfully enter the workforce; and
Grow up in safe communities and get a second chance if they make a mistake.

New York State MBK Goals
In addition to supporting the six milestones set at the national level, New York’s MBK initiative is also committed to:

Ensuring equitable access to high quality schools and programs;
Expanding prevention, early warning, and intervention services;
Using differentiated approaches based on need and culture;
Responding to structural and institutional racism;
Making comprehensive and coordinated support services widely available; and
Engaging families and communities in a trusted and respectful way.

Section I – Organization Information

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* 1. Organization Name:

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* 2. Organization Type:

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* 3. Contact Person:

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* 4. Title:

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* 5. Email Address:

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* 6. Phone Number:

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* 7. Street Address:

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* 8. Borough:

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* 9. Zip Code:

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* 10. Website:

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* 11. Mission:

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* 12. Communities Served:

Section II – Partnering in Support of the Staten Island MBK Initiative: In this section, please check the applicable boxes below to indicate the activities that your organization is willing to support:

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* 13. Our organization is willing to:

Align or expand the services our organization provides to address one or more of the NYS MBK milestones.

Collect and share data on how the services our organization provides are addressing one or more of the NYS MBK milestones.

Host a community outreach event to engage youth and their families and share information about available community resources that support achievement of NYS MBK milestones.

Display and distribute information at our organization’s place of business about available community resources that support achievement of NYS MBK milestones.

Partner with local schools to support achievement of one or more of the NYS MBK milestones.

Start a youth mentoring program.

Personally volunteer to be a youth mentor for an existing mentoring program.

Actively engage and recruit other community partners, faith-based organizations, and local businesses to sign on as participants in the Staten Island MBK Initiative.

Other (please specify)

Many thanks for responding - we will be in touch!