Letter of Intent

Letter of Intent

If your community is interested in participating in the Communities for Children and Youth Initiative, please respond to the following questions. Please note: this is not an RFP or a grant application for program funds. We are inviting ALL Maine communities into a long-term process of leadership development for children. Those communities who become Partners will receive some resources, but these will follow their needs for technical assistance, training and programmatic efforts identified by the strategic plan developed by their Children’s Leadership Council. All communities are encouraged to send in this Letter of Intent.

Community_______________________________________________
Municipality(ies)_____________________________________________________
County_____________________________________________________
Who are (or will be) the members of your Children’s Leadership Council, and what sectors of the community do they represent? At a minimum, your Children’s Leadership Council must include a representative from the following sectors. Please have them sign on the lines below:

	Name	Organization	Phone Number
Education	printed	.	.
	signature	.	.
Social Services	printed	.	.
	signature	.	.
Law Enforcement	printed	`	.
	signature	.	.
Health Services	printed	.	.
	signature	.	.
Young person	printed	.	.
	signature	.	.
Parent	printed	.	.
	signature	.	.
Local Government representative	printed	.	.
	signature	.	.
Non-titled community leader	printed	.	.
	signature	.	.

In addition, your Children’s Leadership Council may have members from the following sectors. Please indicate any additional members below:

	Name	Organization	Phone Number
Business	printed	.	.
	signature	.	.
Civic group	printed	.	.
	signature	.	.
Youth Organization	printed	.	.
	signature	.	.
Religious communities	printed	.	.
	signature	.	.
Local media	printed	.	.
	signature	.	.
Senior Citizen	printed	.	.
	signature	.	.
Other community leaders	printed	.	.
	signature	.	.
	printed	.	.
	signature	.	.
	printed	.	.

Would you like assistance in forming a Children’s Leadership Council?

YES � NO�

At which of the following stages do you see your community?:

�	Individuals have gathered to talk about participating
�	A group already exists that may want to expand their vision and activity in order to participate
�	A group has already done the community team building work and now wants help with the data gathering and assessment process
�	A group is already engaged in prevention efforts and would like assistance with further program development and evaluation (which ones?)
�	A group is ready to mentor other communities. In what areas can you provide expertise?

Why are you interested in participating in the Communities for Children and Youth Initiative? Please respond by attaching a letter of 200 words or less.

Please share some examples (briefly) of the ways your community has worked together in collaboration for a common goal over a significant period of time.

Contact Person:

Name:
_____________________________________________

Address:
_____________________________________________

_____________________________________________

Phone:
_____________________________________________

Fax:
_____________________________________________

E-mail:
_____________________________________________

Communities for Children and Youth, 170 State House Station, Augusta, ME 04333-0170
For questions, please call:

Susan Savell, Executive Director at

1-800-780-6230
Susan.Savell@maine.gov

Thank you for your commitment to children and youth in your community!!

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Name:	_____________________________________________
Address:	_____________________________________________
	_____________________________________________
Phone:	_____________________________________________
Fax:	_____________________________________________
E-mail:	_____________________________________________