2009 NCLR Líderes Summit Application for Financial Support The National Council of La Raza (NCLR) the largest national Hispanic civil rights and advocacy organization in the United States is pleased to announce the availability of financial support to groups that wish to attend the 2009 Líderes Summit and NCLR Annual Conference in Chicago, Illinois, July 24 28, 2009. NCLR will make every effort to assist those who request financial support, but due to limited funds, we cannot guarantee that all requests will be fulfilled. Also, please note that based on our selection process, an applicant may be awarded less than the original amount requested. In order to qualify for financial assistance, applicants must have raised 50% of their total costs through other means NCLR will only award up to one-half (50%) of overall participant expenses (registration, travel, housing, etc.). For example, if expenses total $1,000, then the applicant must have raised at least $500 on his/her own to be eligible for the maximum award. In addition, NCLR will only provide a maximum award of up to $2,000 per group application. Please be conservative with budget estimates. NCLR financial assistance is not guaranteed, and if your application is accepted, you may be offered an amount less than the total you requested. NCLR will make award decisions based on budget submitted, number of people in the group, fundraising efforts, and Affiliate and/or prior Líderes Network membership, as well as on geographic and other diversity. Finally, groups who have not received other forms of financial assistance (e.g. free registrations for workshop presenters) will receive first consideration. All selected applicants will receive written confirmation of their award by June 12, 2009. If financial aid is awarded, all participants must commit to attending ALL Summit activities. Failure to attend any Summit events can result in the forfeit of awarded financial support funds. Financial support will be in the form of reimbursement after NCLR receives receipts and/or appropriate expense documentation in a timely basis. We require all awardees to submit a testimonial about their group s experience at the Summit when they submit their receipts. Testimonials may be posted on the Líderes website, or used in promotional materials. All applicants must be Líderes Network members. If your group/organization is not currently a Líderes Network member, please be sure to check the box on the following page to request addition to the Líderes Network. TO APPLY To apply for financial assistance from NCLR, please fill out and submit the attached application form to dpernick@nclr.org or fax to (202) 776-1796 Attn: Denise Pernick Applications MUST BE RECEIVED by Friday May 15, 2009.
2009 NCLR Líderes Summit Application for Financial Support (Please email completed application to dpernick@nclr.org or fax to (202) 776-1796 Attn: Denise Pernick, by Friday, May 15, 2009) Contact Person: Title or Position: Organization/Program Name: School or Institutional Affiliation: Address: City:
State:
ZIP:
Phone Number:
Email:
Our Group is: An NCLR Affiliate
A Líderes Network Member
Presenting a Workshop at the 2009 Líderes Summit
Note: If your group is not currently a Líderes Network member please check here to join the Network: Total Number in Group Attending the Summit: #
Youth (ages 14 25) and
#
Adults (chaperones, advisors, etc.)
Names of all people attending: (Note: include ages of all youth)
(Add paper if necessary to list all attendees) Arrival Date:
Arrival Time:
Departure Date:
Departure Time:
In Chicago we will stay at (Hotel Name): Please note that NCLR is not offering discounted hotel room rates this year. All rates at the Palmer House Hilton are $199.00 per night for occupancy up to four people.
2009 NCLR LĂderes Summit Application for Financial Support I, , representing (group), do hereby attest that all of the above-named individuals commit to participating in all 2009 NCLR LĂderes Summit activities. I understand that I am assuming responsibility for informing the group of this commitment, and hereby acknowledge on the entire group s behalf that if funds are awarded, failure to comply with attendance rules can result in forfeit of those funds.
Signature
Date
For more information, please contact Denise Pernick at (202) 785-1670 or via email at dpernick@nclr.org
2009 NCLR LĂderes Summit Application for Financial Support Estimated Costs Worksheet (Use this form or your own. Please provide as much detail as possible.) Item
Cost
Registration $250/participant X
participants
$
Travel Mode of transportation: Cost per ticket: $ X participants or Estimated transportation expenses (van rental, etc. describe):
$
Hotel (Entire Summit is six nights, Thu. July 23 Tues. July 28) $
/night X
rooms X
nights
$
Food (two dinners on your own during Conference) $
per meal X
participants X two (2) meals
$
Other Costs Describe:
$ $
Total Costs:
$
Total Funds Raised: Sources and Amounts: $ __________________________________________________________ TOTAL FUNDS REQUESTED:
$ $
ADDITIONAL INFORMATION (Describe your fundraising efforts and/or explain any special circumstances about your application. Attach extra pages if necessary.)