Harnessing Our Power of Experience (H.O.P.E.)
Leadership Institute Info & Application Package
Benefitting SD communities
Supporting the new generation of peer leaders in SD
2015 Institute Information:
Institute Overview:
The H.O.P.E. Leadership Institute invites the participation of people who have lived experience with trauma,
altered/extreme states and/or diagnosis of mental illness. Struggling to overcome the tremendous life challenges
that often result yields a depth of experience that can provide valuable insight well beyond the individual.
Through involvement with others in peer run programs like the H.O.P.E Leadership Institute, we grow capacity
to transition from isolated individuals who struggle in silence to valued members of the peer community
contributing to the health and wellness of our community at large.
The H.O.P.E. Leadership Institute is an opportunity to come together with others who have had similar
experiences to explore the ways that, through our unique and shared wisdom, we can lead change efforts toward
healthier and more inclusive communities. The Institute provides opportunities to work with others who have
similar interests and leadership goals. Up to 25 participants will be selected through the application process and
will work closely in groups of 3-5 people on one of 5-7 Leadership Institute projects (projects chosen by
participants). At the close of the 2015 Leadership Institute, participants will be provided with certificates of
completion at the Institute closing session. The Institute experience is designed to benefit participants with a
variety of future leadership opportunities they may choose to pursue, whether within, in partnership, or outside
the scope of SD United for Hope & Recovery activities.
Important Dates:
April 25: Application Deadline
May 1: Applicants notified
May 28-29 (travel May 27th, 29th) Institute kickoff session
July 22-24 (travel July 21st, 25th) Institute closing session
Requirements for Participant Consideration:
 Attend both the kickoff and closing sessions (financial assistance available)
 Devote at least one (1) hour per week to small group Leadership Institute activities from June 1st 2015
through July 31st 2015
 Submit expense documentation (a travel packet with instructions and a SASE will be provided)
 Notify SD United for Hope & Recovery if (s)he cannot attend
 Complete and return the anonymous H.O.P.E. Leadership Institute survey within 2 weeks following the
completion of July activities
Application Instructions:
Fill out each section, use additional sheets if necessary. Demographic information is voluntarily. You may type
the application directly or print out a copy and fill the application out by hand. If you would prefer to fill out the
application verbally, or if you have questions about filling out the form, please call our message line at
605-549-5509 or toll-free at 1-844-894-HOPE(4673). Please leave your first name and a callback number, and
a SD United representative will return your call promptly to assist you. If you are filling out the form yourself,
please return the form using one of the options below.
1. by email: info@southdakotaunited.org
2. by post: SD United for Hope & Recovery
420 East Saint Patrick Street # 109 Rapid City, SD 57701
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2015 Institute Information
Application deadline: April 25, 2015
Contact Information
Please PRINT the following information as you would like it to appear on the participant list.
First Name:
Last Name:
Title:
Street Address:
City:
Telephone: (
E-mail:
State:
)
-
Alternate Telephone: (
ZIP code:
)
-
Alternate E-mail:
Demographic Information
(Optional, we seek to maximize diversity of cultural perspective and life experience)
Gender/
Physical Disability Age
Ethnicity
Lived Experience
Orientation
(check all that apply)
 Male
 Yes
 18-26  Asian/Pacific Islander  Unique/Unusual Beliefs
 Female
 No
 27-39  American Indian
 Extreme/Altered States
 40-55  Alaska Native
 Mental Illness Diagnosis
 LGBTQI2S
 56+
 Black
 Addiction/Substance Abuse
 Heterosexual
 Hispanic
 Military/Veteran
 White
 Trauma History
 Other (Specify)_____  Incarceration History
_________________  Other (Specify) ________
Financial Support and Accommodations
 Yes  No
Have you attended any SD United for Hope & Recovery events in the past?
If yes, please list events/year(s)?_____________________________________________
 Yes  No
Are you requesting financial assistance with hotel accommodations?
If Yes, please list any accessibility need(s).____________________________________
 Yes  No
Are you requesting assistance with mileage costs for transportation in your personal
vehicle?
 Yes  No
If yes, are you willing to assist others from your area in transportation to face to face
portions of the Institute? (must have a valid driver’s license and current insurance)
 Yes  No
Are you requesting assistance with transportation including vehicle?
If yes, please list any accessibility
need(s):_____________________________________
 Yes  No
Are you requesting assistance with meals and incidentals?
If Yes, please list any specific dietary needs(s):__________
_______________________
Additional Information
On a separate piece of paper, please provide your answers to the following questions:
1. Why do you wish to attend the H.O.P.E. Leadership Institute?
2. How will you utilize what you learn through participation in the H.O.P.E Leadership Institute?
3. What are the specific issues, related to leadership, in which you are most interested?
4. Are you currently involved with any related programs or activities? If yes, please describe.
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