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Speakers Bureau Application

The Pennsylvania Child Welfare Resource Center, in collaboration with the Office of Children, Youth, and Families, would like to provide individuals with lived experiences in foster care an opportunity to share their unique perspective of the child welfare system in Pennsylvania through a Speakers Bureau. This platform will provide an opportunity to enhance statewide permanency efforts and improve outcomes for children, youth, and families.

This application helps to identify your areas of expertise based on your lived experience. Your information allows us to best connect you to committees and workgroups that share your interests. It is important that we have a selection of candidates who vary in age, race, demographics, and system experience to ensure the best representation of youth in foster care.

Please note that you will be compensated for your participation based on the hours involved in your role, which may include working on committees and workgroups with child welfare professionals or participation in speaking engagements, trainings, and panel presentations.

First Name:*

Last Name:*

Date of Birth:*

Mailing Address 1:*

Mailing Address 2:

City:*

State:*

Zip Code:*

What county or region are you from?*

Email address:*

Cell phone number:*

Evening telephone number:*

Best time to call you:*

Emergency contact name:*

Emergency contact telephone:*

1. If you are in school, please tell us the last grade you completed. If you are in post-secondary education, please include your major or vocational studies.*

2. Are you currently employed?*

2a. If yes, are you currently employed:*

3. Do you have your own transportation?*

3a. If no, what support would you need?*

3a. If yes, please select the type of transportation:*

4. Are you currently in foster care?*

5. Length of time in foster care:*

6. Number of placements while in care:*

7. Did you age out of care between the ages of 18-21?*

7a. If yes, what year did you transition out of care?*

8. Did you come back into care after leaving?*

9. Types of placements while in care. Please check all of the placement types that you have been in while in care or after transitioning from care:

10. Please provide a summary of your lived experience within systems i.e. child welfare, juvenile justice etc.). If you were involved in more than one system at the same time (for example child welfare and juvenile justice), please include that information:*

11. Are you now, or have you ever been a member of an advisory board, involved in any community organizations, participated on any committees, or workgroups?*

11a. If yes, please describe:*

12. Have you facilitated or co-facilitated a meeting, presentation, or workgroup?*

12a. If yes, please describe your role:*

13. Have you participated in a panel presentation?*

13a. If yes, please describe your role:*

14. Have you participated in PA Youth Advisory Board Trainings (Strategic Sharing, Know Your Rights (KYR), YAB 101, etc.)?*

14a. If yes, which ones?*

15. Please check any of the following topics that are of interest to you or you have experience/expertise in:

Adoption

Adoption and Voluntary Post-Adoption Contact Agreements

Age-Appropriate Freedoms

Diversity, Equity, and Inclusion

Domestic Violence

Drugs and Alcohol

Education

Family Group Decision Making

Foster/Kinship Care

Group Homes

Homelessness

Improving Case Worker Quality

Independent Living (IL) Programs - Transitioning to Adulthood

Juvenile Probation

LGBTQ+

Life Skills Class

Maintaining Family Connections

Mental Health/Wellness

Mentoring Youth/Peers

Older Youth Retreat

Pregnant and Parenting Teens/Young Adult

Residential Treatment Facility (RTF)

Sibling Visitation

SWAN Units of Service

Youth Advisory Board (YAB)

Reference forms will need to be completed as part of the application process. Please identify three required references and include their contact information in the area listed below. One of your references should be from a supervisor or professional. The Resource Center will contact your references and provide them with the form needed to fully satisfy this application requirement.

Reference 1

Name:*

Relationship:*

Address:*

City:*

State:*

Zip Code:*

Phone:*

Email Address:*

Reference 2

Name:*

Relationship*

Address:*

City:*

State:*

Zip Code:*

Phone:*

Email Address:*

Reference 3

Name:*

Relationship:*

Address:*

City:*

State*

Zip Code:*

Phone:*

Email Address:*