Step 1: Basic Questionnaire

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* 1. What is the best way to reach you?

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* 2. What inspired you to apply to be the Survivor Keynote for Stargazing 2017?

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* 3. What do you propose as the main point of your keynote presentation? Please keep in mind that the focal point of your presentation should be around the theme of healing.

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* 4. Who will be providing you with support throughout the process of preparing and delivering your keynote presentation at Stargazing 2017?

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* 5. Are your loved ones aware of the details shared in your keynote presentation?

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* 6. Are you currently seeing a therapist?

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* 7. If not, are you interested in information regarding local support groups to attend during your preparation time? (EVE and MSU SAP have this available)

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* 8. Describe your experience and comfort level with public speaking.

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* 9. If selected, can you commit to practicing for 1-1.5 hours a month in April, May and June (place & time TBD) with a final dress rehearsal performed in front of the foundation Board of Directors on July 18th, 2017 at 6:15 p.m.?

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* 10. If you are selected, the foundation will be using social media to promote Stargazing 2017. If you are willing to be mentioned (tagged, regramed, etc.), please share your account information here.

Step 2: Your full written presentation (1-2 pages) and powerpoint (10 slides or less) are due by March 15, 2017 at 8 p.m. EST. If possible, also include a photo of yourself and a short bio of 400 words or less. Please email these materials to info@thefirecrackerfoundation.org with the subject line: SURVIVOR KEYNOTE SUBMISSION.

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