Nomination Form and Survey

In early 2012, the National League of Cities Institute for Youth, Education and Families will publish a report on small and mid-sized city (populations under 75,000) initiatives to strengthen families and improve outcomes for children and youth. The report will not only highlight several cities that have implemented comprehensive plans to support children, youth and families, but will also feature innovative small city efforts in early childhood development, education and afterschool, family economic success, youth civic engagement, health and wellness, youth employment and improving outcomes for at-risk youth. Municipal officials and staff are invited to nominate an example from their community to be included in this publication and to share their thoughts on the unique opportunities and challenges that small cities face in taking action on behalf of children and families. Please complete this form by the end of April 2012.

* 1. Name

* 2. Title/Organization

* 3. City/Town

* 4. In what state or U.S. territory do you live?

* 6. Email

* 7. Phone

* 8. Name of Local Initiative

* 9. Issue Area (check all that apply)

* 10. Brief description of initiative, including the problem it is intended to address, the role of your city government, and how the initiative is financed (1-2 paragraphs)

* 11. In your opinion, what unique challenges do small cities face in launching initiatives for children, youth and families?

* 12. In your opinion, what unique opportunities are available to small cities seeking to launch initiatives for children, youth and families.

* 13. What types of support and assistance do small cities need to make sustained progress in improving outcomes children, youth and families?