Partner Agency Nomination Form
We're excited that you have nominated a youth to attend Camp HOPE America 2025! Camp HOPE America is the first camping and mentoring initiatives in the United States to focus on children exposed to domestic violence and child trauma.
Please answer the questions below so that we can know a little bit more about the child you're nominating. Due to limited space, please note that we are not able to guarantee attendance for any child. We will be conducting screening interviews with children and their caregivers before officially offering spots for camp. Thank you for your understanding!
Name
First Name
Last Name
What is your relationship to the youth?
Phone Number
Please enter a valid phone number.
Email
example@example.com
Full Name of the Youth You Are Nominating
First Name
Last Name
What services is this youth currently recieving (therapy, childcare, etc)
How long ago did this child experience/witness domestic violence or another form of abuse?
Is this youth current in a stable home environment (i.e was not recently put into foster care, no longer lives with the abuser, etc)
Please Select
Yes
No
Please describe the youths current living situation.
Has this youth had the opportunity to process their trauma with a mental health professional? If so, please describe.
How has you seen this child handle conflict or not getting his/her way? Dow does the child handle conflict?
Does the child have any known behavorial issues? If yes, please describe.
If this youth has had behavioral difficulty in school recently, what has been the nature of that difficulty?
What are some potential challenges that might arise if this child attends overnight camp?
What do you believe that this child/family would gain from involvement in Camp HOPE America?
Is there anything additional that would be helpful for us to know in advance?
Submit
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