Application: South Carolina Afterschool Leaders Empowered

Name Name First Last
Job Title
School district(s) your afterschool/summer program(s) serve:
Which of the following best describes the area your program serves?

Which of the following best describes the area your program serves? Rural Urban Suburban
Which of the following best describes your organization?

Which of the following best describes your organization? School or district Faith-based Community-based For profit
Is your program funded by 21st CCLC?

Is your program funded by 21st CCLC? Yes No
Are you a member of the SC Afterschool Alliance?

Are you a member of the SC Afterschool Alliance? Yes No
In a few words, describe the youths served in your program.
Company/organization name:
Physical address of your organization/program: Physical address of your organization/program:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Best mailing address for us to send your acceptance packet, class materials, etc.: Best mailing address for us to send your acceptance packet, class materials, etc.:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Office phone Office phone - ### - ### ####
Cell phone Cell phone - ### - ### ####
What is your gender? (optional)
What is your race? (optional)
Dietary accommodations or needs:
Any other special accommodations:
Please tell us why you are interested in participating in the 2024 cohort of South Carolina Afterschool Leaders Empowered.
Describe your current role in afterschool and/or summer learning and your relationship with your school district.
What information, tools, and competencies would be most helpful for you in learning how to expand high-quality, evidence-based afterschool and/or summer learning in your district or organization?
Please describe in one paragraph your community’s greatest needs related to afterschool and expanded learning.
Over the coming year, you will be asked to work on a project that impacts your organization. Projects typically focus on one or more of the following: improving program and/or staff quality, growing your program to include more youth, or strengthening the funding and sustainability of programs.

If selected for this fellowship, describe how you might “SCALE Up" afterschool or summer programming in your organization.
What is unique in your experience and/or background that prepares you well for this opportunity?
Are you available to spend the week of January 28-February 1, 2024, at Furman University in Greenville, SC? All lodging, meals, and travel expenses will be covered.

Are you available to spend the week of January 28-February 1, 2024, at Furman University in Greenville, SC? All lodging, meals, and travel expenses will be covered. Yes No
Are you fully committed to participating in a yearlong leadership and learning experience throughout 2024?

Are you fully committed to participating in a yearlong leadership and learning experience throughout 2024? Yes No
Do you intend to remain at this organization/in the field of afterschool and summer learning for at least 18 months?

Do you intend to remain at this organization/in the field of afterschool and summer learning for at least 18 months? Yes No

If your status should change unexpectedly, please notify SCALE staff immediately.
Please upload a letter of support from your direct supervisor, principal, or superintendent. This letter should indicate their willingness to support you throughout the fellowship, and their understanding that you will lead the charge to "SCALE Up Afterschool" in your community.

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