Name* First Last Phone Number*E-mail Address* School* Expected Graduation Date* Home/Voting Address*Please provide your home or voting address. Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of BirthDate of Birth MM slash DD slash YYYY Parent or Legal Guardian's Information (if under age 18)Parent or Legal Guardian's Information (if under age 18) Parent or Legal Guardian's Phone NumberParent or Legal Guardian's Email Address Why are you passionate about ensuring access to high-quality early learning for every U.S. child?*Why are you passionate about ensuring access to high-quality early learning for every U.S. child?Why are you passionate about helping children suffering from poverty and violence around the world?*Why are you passionate about helping children suffering from poverty and violence around the world?Have you ever participated in any advocacy, community, or volunteer work? If so, please describe.*Have you ever participated in any advocacy, community, or volunteer work? If so, please describe.What do you hope to learn or what skills do you hope to gain from attending the 2020 Advocacy Summit?*What do you hope to learn or what skills do you hope to gain from attending the 2020 Advocacy Summit?How do you see yourself implementing the knowledge and skills learned at the Advocacy Summit at your school?*How do you see yourself implementing the knowledge and skills learned at the Advocacy Summit at your school?Students who attend the Advocacy Summit and attend school in one of these states (CO, IA, IL, LA, NH, NM, RI, SC, TN, VT, WA) will be expected to become involved in SCAN’s Student Ambassador Program, a network of high school and college students around the country working on local and national advocacy efforts to promote issues affecting kids. If chosen to attend, will you commit to participating in the Student Ambassador Program for at least one year?*Students who attend the Advocacy Summit and attend school in one of these states (CO, IA, IL, LA, NH, NM, RI, SC, TN, VT, WA) will be expected to become involved in SCAN’s Student Ambassador Program, a network of high school and college students around the country working on local and national advocacy efforts to promote issues affecting kids. If chosen to attend, will you commit to participating in the Student Ambassador Program for at least one year? Yes No (Explain below.) N/A If you cannot commit to participating in the Student Ambassador Program, why not?If you cannot commit to participating in the Student Ambassador Program, why not?
