2027 Mother's Leading Change Retreat Application

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

What is your relationship to an individual with Down syndrome?

What is the age of the individual with Down syndrome in your life?

Tell us a little about yourself and your journey with Down syndrome.

What is something you have learned as a mother or caregiver that you wish someone had shared with you earlier?

Which areas would you most like to learn more about during the retreat? Check all that apply.

Tell us about the community where you live. What resources or supports for individuals with Down syndrome and their families are available in your area?

What do you believe is one of the greatest unmet needs for individuals with Down syndrome or their families in your community?

How would you like to make a difference for people with Down syndrome and their families in your community?

Following the retreat, would you be willing to share information or resources with other families in your community?

Which of the following would you be interested in doing after the retreat? Check all that apply.

Imagine it is six months after the retreat. What is one thing you would like to have accomplished because of what you learned or the relationships you developed during the retreat?

Is there a question, challenge, or topic you especially hope we address during the weekend?

By submitting an application to the retreat, you agree to the following terms and conditions:

I understand that this is an interactive leadership retreat and, if selected I agree to participate in all retreat sessions and activities.
I am willing to help identify resources, information, or strategies that could benefit other New Mexico families.
Following the retreat, I will follow the Community Action Plan and remain in contact with retreat organizers to advocate for change and support in my community.
If selected I agree to confirm my participation within 72 hours following an acceptence letter.
I understand that space is limited if I need to cancel, i will do so no less than 4 weeks prior to the Retreat.
I understand that if I cancel less than 4 weeks prior to the retreat, I am responsible for hotel costs of $250.

Signature

Women’s Leadership Retreat Application

Your Connection to Down Syndrome