Form Online (Web) Form Online (Web) Form Native Youth Climate Adaptation and Leadership Congress

(Rev. 06/2023) OMB Control No. 1018-0176

U.S. Department of the Interior Expires ##/##/20##

Native Youth CLIMATE Adaptation Leadership Congress

Application Preview and Directions

Thank you for your interest in NYCALC 20##! The online application should be filled out individually by each student. Single community teams composed of a minimum of 3 to a maximum of 5 students will be accepted so please fill out the application to the best of your ability! Below is a preview of the application questions. The application, once opened, cannot be revisited to edit, or completed later. WE STRONGLY ENCOURAGE YOU TO REVIEW AND WRITE/PLAN YOUR ANSWERS PRIOR TO OPENING THE APPLICATION. YOU CAN COPY AND PASTE YOUR PRE-WRITTEN ANSWERS INTO THE GOOGLE FORM APPLICATION.

Parts I – III must be completed individually. Part IV may be completed as a group. All sections will be scored.

Part I – Student Information:

This is your basic personal information (Name, Nickname, Birthday, Community/Tribal Affiliation, Address, Phone, Mentor Name, School Name and Address, Grade, Email).

PART TWO – Student Insight:

Please choose one of the following questions to answer to help us learn more about you. In approximately 100-200 words, you may answer the question in written format or other media of your choice, for example a video of song, dance, or poetry.

1. Have you ever used your personal story to inspire change? If you have, give an example. If not, give a reason why that is the case.

2. Tell us of one environmental problem you see in your community and where you believe the solution lies.

- Give some concrete steps that you could possibly take to work towards said solution. Examples: Lack of connection with the environment and thereby decreased stewardship/conservation, dependency and comfort in technology and unfamiliarity with disconnecting and experiencing things independently firsthand

3. What steps do you take to ensure you continue to grow and develop as a leader?

4. Your Choice: Share with us something about yourself that you’d like us to know/be aware of.

PART THREE – Short Answer Info:

Provide short answers to the following questions. These questions are designed to gain insight into how involved you are in your community and school life. Please fill out this short answer section as completely as possible in the space provided. Please write anything within your lifetime you find relevant.

1. Extracurricular activities, school clubs or organizations you currently participate or have previously participated in (ex: spiritual groups, sports, activism, recreational activities, performances):

2. Volunteer experience (ex: Food Bank, donation drives, community clean-ups, etc.):

3. Accomplishments or awards you have received and what year/semester:

4. Other strengths, qualifications, and/or obstacles you have overcome you would like the application reviewers to consider.

PART FOUR – Short Answer Info:

This portion should be a preliminary project idea that will be developed throughout the Congress. By participating in NYCALC, you have the opportunity to potentially earn a mini grant to help put your project idea into action upon return from the Congress. THIS IS THE ONLY PORTION THAT CAN BE COMPLETED AS A GROUP. IT CAN ALSO BE COMPLETED AS AN INDIVIDUAL.

Answers should be complete sentences. When brainstorming a conservation-based project consider your passions, skill sets, and your community's needs. Please outline your/your groups idea with the following format. You may use this same format to apply for the mini-grant opportunity following NYCALC.

1. Project Goal and Summary

2. Who is your audience? Why are they important?

3. How would you implement this project, and what tools would you need to be successful?

4. Would you need additional support (ex: volunteers, other schools, professionals, neighboring communities)?

5. When would your project be completed? Is it a one-time project or ongoing over many years into the future?

NOTICES

PRIVACY ACT STATEMENT

Authority: The information requested is authorized by the Government Organization & Employee Training Act (5 U.S.C. 4101, et seq), Executive Order 11348 (Providing for Further Training of Government Employees), Americans with Disabilities Act and the E-Government Act of 2002, (42 U.S.C. 112101) and the E-government Act of 2002 (44 U.S.C. 3501).

Purpose: To enroll students for National Conservation Training Center hosted programs.

Routine Uses: The information on this form may be used by program leaders to contact those selected for the NYCALC program. Information may be disclosed to the Department of Justice (DOJ), a court, adjudicative or other administrative body, the fiscally sponsoring organization or agency of the student, a party in litigation before a court or adjudicative or administrative body; or any DOI employee when represented by DOI or DOJ for legal proceedings or as required by law pursuant to the routine uses identified in the System of Records Notice: INTERIOR/DOI-16, Learning Management System, available at https://www.doi.gov/privacy/doi-notices.

Disclosure: Providing the requested information is voluntary. However, failure to provide the information may prevent participation in the program.

Paperwork Reduction Act Statement

We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501 et seq.) to assure the health and safety of participants while on site at the National Conservation Training Center for the Congress. Your response is voluntary and we will not share your response publicly. We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB Control Number. OMB has reviewed and approved this information collection and assigned OMB Control Number 1018-0176.

Estimated Burden Statement

We estimate it will take 4 hours to complete the application form, including time to read instructions and gather information. You may submit comments on any aspect of this information collection to the Service Information Collection Clearance Officer, U.S. Fish and Wildlife Service, 5275 Leesburg Pike, MS: PRB (JAO/3W), Falls Church, VA 22041-3803, or via email at [email protected]v. Please do not send your completed form to this address.

Page 1 of 4