Application Deadline: April 21, 2008

*Please complete and return to: NCCJ Phone: (205) 322-4100

P.O. Box 55911 Fax: (205) 322-4069

Birmingham, AL 35255

Name: ___________________________________Address: ___________________________________

City: _______________________State: ____________________Zip: ________

Phone Number: ( ) E-mail:___________________ Birth date: _____________

To ensure diversity at ANYTOWN, please check all applicable spaces below.

Gender: Male [ ] Female [ ]

Race: African American (black) [ ] Asian [ ] Caucasian (white) [ ]

Hispanic [ ] Middle Eastern [ ] Native American [ ]

Other (please specify)

Religion: Buddhist [ ] Catholic [ ] Hindu [ ] Jewish [ ] Muslim [ ] Protestant [ ](please specify)

Other [ ] (please specify)

Name of church, mosque, temple (if applicable) _________________________________________________________________________________

Name of high school ______________________________________________________________

Please check the class you will enter in the Fall of 2007:

Sophomore [ ] Junior [ ] Senior [ ]

Have you applied to ANYTOWN ALABAMA in the past? Yes [ ] No [ ]

Have you attended the Make A Change Leadership Institute? Yes [ ] No [ ]

Are you an NCCJ Heritage Panelist? Yes [ ] No [ ]

Can you participate in the entire week of ANYTOWN -- June 1-7, 2008? Yes [ ] No [ ]

Personal Statement

*** On a separate sheet of paper please explain: Why you wish to attend ANYTOWN, including what strengths you would bring to the ANYTOWN experience, what you hope to learn, and how you plan to use the ANYTOWN experience back in your school, congregation, and community.

Please limit your response to one page. ***

Dear Applicant and Parent(s):

ANYTOWN ALABAMA is a significant program for both delegate and family. We encourage the delegate’s family to be part of this experience. Delegates and parents will be invited to both pre- and post-camp meetings. Please read over the following information to give you a clear picture of ANYTOWN. All applications must include a completed and signed Delegate Application and Reference Form.

Cost of ANYTOWN:

$450. The cost of ANYTOWN includes all meals, transportation, lodging, educational materials, camp T-shirt and camp photo. Full and partial scholarships are available to delegates based on need. No one will be prevented from attending Anytown because he or she cannot afford the fee. If your participation depends on receiving financial aid, please check below. Neither staff nor delegates will know how much, if any, financial assistance is given to anyone. Send no money until notified of acceptance.

[ ] I request financial assistance. (All financial requests will be accepted.)

Mission Statement:

ANYTOWN ALABAMA builds a community of empowered youth to become leaders in building an inclusive 21^st century.

Goals:

Building Community- ANYTOWN provides a safe environment for a diverse group of young people and adults to build an inclusive community in which individuals are not discriminated against or excluded based on race, culture, religion, gender or any other difference. Delegates learn that an inclusive community, founded on dialogue and respect, allows individuals to “disagree without being disagreeable.”

Empowering Youth- ANYTOWN provides a training ground for youth to exercise their power as young adults and view themselves as agents of change. Delegates are treated with respect; their opinions and ideas are taken seriously, and their cultural identity is celebrated.

Training Leaders- ANYTOWN provides an opportunity for all delegates to view themselves as leaders. Through modeling diverse leadership styles, the staff will serve as coaches to help delegates sharpen their communication skills and learn about issues that divide people.

Building an Inclusive 21^st Century- ANYTOWN serves as a model for building an inclusive community where individuals work to reduce discrimination and oppression. Delegates leave ANYTOWN motivated to “help make any town an ANYTOWN.”

Learning Objectives:

Ÿ To teach skills for clear and positive communication.

Ÿ To gain a deeper understanding of prejudice, discrimination, and the systems of privilege in society.

Ÿ To create a safe environment for dialogue and discussion.

Ÿ To build an inclusive community through affirming and supportive activities.

Ÿ To make friends across racial and cultural lines.

Ÿ To explore who we are in relation to others.

Ÿ To gain a greater understanding of what being a part of an “inclusive community” means and how to begin making it happen.

Ÿ To increase self-confidence through self-awareness.

Parent Name Relationship to Applicant

Parent Signature Date

Applicant Signature_____________________Date____________________