Learning Collaborative Team Application

Thank you for your interest in the Family Engagement and Leadership in Systems of Care Multi-Disciplinary Learning Collaborative.

The collaborative will meet between the months of September 2023 and May 2024. We estimate the time commitment per month to be an average of 5 hours.

At minimum, all teams must include the following members:

Representation from a family-led organization
At least two family / caregiver representatives
At least one youth representative

The remaining group members can be from a wide variety of disciplines such as clinicians/practices, schools, early childhood systems, mental/behavioral health systems, payors, community-based organizations, workforce development initiatives, among others.

Team selection will be based on the following areas of priority:

Diversity of teams
Geographical representation and need
Plans to include family and youth partners meaningfully

Questions? Please contact:
Melanie Lindsay, FELSC Project Coordinator

mlindsay@familyvoices.org

Question Title

* 1. Person Completing Application:

Name

Organization Affiliation

Address

City/Town

State/Territory

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Please designate the organization & team member who will handle disbursement of the stipend among the team members (If different than the individual completing this form).

Name

Company / Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 3. Please list proposed team members, including:
name, email, organization (if applicable), discipline represented:

Representative of a family-led organization such as an F2F

Family member/ caregiver of CYSHCN

Youth or young adult with SHCN

Additional Partner

Question Title

* 4. Please describe how you plan to engage your family and youth partners and make group activities accessible to them.

Question Title

* 5. Accepted teams will be paid a stipend of $4,500, of which all family and youth partners should receive a portion. Please describe how you will compensate these participants. Note: Family Voices recommends a minimum stipend of $20-$30 per hour for youth and family leaders.

Learning Collaborative Team Application

Question Title

* 1. Person Completing Application:

Question Title

* 2. Please designate the organization & team member who will handle disbursement of the stipend among the team members (If different than the individual completing this form).

Question Title

* 3. Please list proposed team members, including:
name, email, organization (if applicable), discipline represented:

Question Title

* 4. Please describe how you plan to engage your family and youth partners and make group activities accessible to them.

Question Title

* 5. Accepted teams will be paid a stipend of $4,500, of which all family and youth partners should receive a portion. Please describe how you will compensate these participants. Note: Family Voices recommends a minimum stipend of $20-$30 per hour for youth and family leaders.

Question Title

* 6. Why are you interested in this opportunity?

Question Title

* 7. Please list any accommodations that any of your team members will need in order to participate in the meetings held by Family Voices & NICHQ:

Learning Collaborative Team Application

Question Title

* 1. Person Completing Application:

Question Title

* 2. Please designate the organization & team member who will handle disbursement of the stipend among the team members (If different than the individual completing this form).

Question Title

* 3. Please list proposed team members, including:name, email, organization (if applicable), discipline represented:

Question Title

* 4. Please describe how you plan to engage your family and youth partners and make group activities accessible to them.

Question Title

* 5. Accepted teams will be paid a stipend of $4,500, of which all family and youth partners should receive a portion. Please describe how you will compensate these participants. Note: Family Voices recommends a minimum stipend of $20-$30 per hour for youth and family leaders.

Question Title

* 6. Why are you interested in this opportunity?

Question Title

* 7. Please list any accommodations that any of your team members will need in order to participate in the meetings held by Family Voices & NICHQ:

* 3. Please list proposed team members, including:
name, email, organization (if applicable), discipline represented: