Section 1 of 1 in this document
Receipt
You will be provided with a Receipt upon submission.
JumpStart Community Safety Summit
The JumpStart Community Safety Summit will be a day of learning and networking for organizations and grassroots community leaders who are working to impact our Charlotte community in the areas of Crime Prevention, Conflict Mediation, Opportunities for Youth, Addressing Racial Segregation, and Family Stability. The Summit will be held August 10 at the Goodwill Opportunity Campus located at 5301 Wilkinson Blvd, from 8 am to 5pm.
Full Name
First Name
*
Last Name
*
Full Address
Street Address
*
City
*
State
Zip
*
Email
*
Phone Number
*
Organization Name
*
What best describes your role in the community?
Funder
Grassroots Leader (does not get paid for their work and is not affiliated with a neighborhood organization)
Neighborhood Leader (does not get paid for their work and is affiliated with a neighborhood organization)
Non-Profit Leader (volunteer, staff or board member of a non-profit organization)
Other (please specify)
Which of the following JumpStart themes interests you the most?
Crime Prevention
Conflict Mediation
Opportunities for Youth & Parents
Family Stability
Addressing Racial Segregation
Do you have any dietary restrictions?
none
Vegetarian
Vegan
No red meat
halal or kosher
nut allergy
gluten free
other
How would you best describe your constituents? Please check all that apply
Young People under 25
Aged 26-55
Aged 55 and older
Low Income Households
People of Color
Immigrants & Refugees
East Charlotte
West Charlotte
North Charlotte
South Charlotte
Other group
Please enter the primary zip code in which you do your work
*
Are you a current or previous grantee?
*
Choose One
Yes
No
disregard this