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LET(s)Lead Academy New England

Application Form Contact Information Name

Street Address

City, State, ZIP

Phone

E-Mail Address

Participant Requirements ___ I self-identify as a person with first-hand lived expertise of recovery. ___ I have access to a computer, reliable internet/Wi-Fi access, & equipment as described

below. ___ I can attend a 2-hour online class once each week for 10 weeks. ___ I will devote at least 6 hours of reading and related commitments between classes. ___ I will attend monthly mentoring sessions at least 1 time per month for 5-6 months after the 10-week online portion of the training and monthly classes. ___ I reside in one of the 6 New England States: CT, MA, ME, NH, RI, VT.

Required Basic Computer Specifications The training will use Zoom for videoconferencing.

Please go to https://support.zoom.us/hc/en-us/articles/201362023-System-Requirements-for-PC-Mac-and-Linux for specific information. (Please note: if you have done webinars or videoconferencing from your computer, you more than likely meet the basic requirements. Most computers purchased in the past 4 years meet these requirements.)

Basic System Requirements include:

• An internet connection—broadband wired or wireless (3G or 4G/LTE or faster)• Speakers and a microphone-—built-in or USB plug-in or wireless Bluetooth• A webcam or HD webcam—built-in or USB plug-in• Or, an HD cam or HD camcorder with video capture card

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Why are you a(n) (emerging) leader? and, How might you benefit from participating? In 500 words or less, please address each question in this section: 1) Why do you consider yourself a(n) (emerging) leader? Please tell us about your passion and vision, for transformational change (interests, issues or causes). 2) How might participating in the Academy further your vision/goal(s) as a leader/change agent? and, 3) How might your visions and goals of transformative leadership be inspired and impacted by your personal lived experience of recovery (e.g. experiences that involve mental health/addictions/trauma/homelessness/incarceration….)?

Transformational Change Project All Fellows must develop a project over a 5-6-month period. Please describe the areas you would focus on during your time with LET(s)LEAD. What are some of possible projects you want to work on and why is that important to you and to others in your community, state, and/or to the larger New England community?

Previous Leadership Experience In 250 words or less, please tell us what experience you have in community leadership (social change or other initiatives). Have you built support for a cause of any kind (small or big)? What was the experience like? Did you work alone or with others or a group (formal or informal)? Have you taken any steps towards developing a new concept or idea that you are passionate about? If so, please describe. If not, what do you think would be needed to get you to that next step?

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Optional Information Please check the boxes below as applicable.

Optional demographics (please check all that apply):

___ African American/Black ___ Native Hawaiian/Pacific Islander ___ Asian American ___ Native American/ American Indian ___ Hispanic/Latino/a/x ___ Multiple racial/ethnic identities (Please specify.)

___________________________________________

Please also check if you identify with one or more of the demographics below:

___ Young Adult ___Veteran ___LBGTQ

___ Other than listed (Please specify.) ___________________________________________

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a participant, I am making a commitment to full participation and attendance for all the requirements of the training.

Agreement and Signature Name (printed) Signature Date

Application Deadline: February 28 by Midnight Questions?

Visit https://mhttcnetwork.org/centers/new-england-mhttc/lets-lead-academy-learning-collaborative

E-mail Maria Restrepo-Toro, BNS, MS, Project Manager, New England MHTTC, maria.restrepo-toro@yale.org.

What’s Next? A committee will review all complete applications. Applicants being considered for selection will be interviewed. All applicants will be notified of acceptance, or non-acceptance. Thank you for completing this application form and for your interest.

Chyrell Bellamy, MSW, PhD. Director of LET(s)Lead Academy, Associate Professor of Psychiatry, Yale University