PARTNER PLAN ACT COLLABORATION INSTITUTE

PARTNER PLAN ACT COLLABORATION INSTITUTE

Request for Supports

For detailed information about Cohort 8 of the Partner Plan Act Collaboration Institute, please read Information for Request for Supports before completing this form.

Collaborations must complete a consultation call with Ruby Flores, Training and Coaching Manager, prior to submitting this Request for Supports. Please contact Ruby at floresr@actforchildren.org well before the submission deadline to arrange a consultation call at which all collaboration team members must be present.

The Request for Supports is comprehensive. It should be completed with collaboration members and submitted by the collaboration leader no later than June 13, 2025. Collaborations will be notified of the results by June 20, 2025.

Indicate the date your collaboration team completed a consultation call with Ruby Flores, Community Systems Statewide Supports (CS3) Training and Coaching Manager or your current Collaboration Institute coach, prior to submitting your RFS:*

Indicate that your entire collaboration is aware of and has agreed to request supports from the Collaboration Institute:*

Yes

Indicate that every member of your team has the authorization and full support of their supervisor to participate:*

Yes

Collaboration name:*

Collaboration area of service:*

Team Members

Collaboration teams must consist of at minimum two and up to five members.

Team Member #1: Name*

Primary Collaboration Lead/Convener/Coordinator/Staff

Team Member #1: Collaboration role(s)*

Team Member #1: Email address*

Team Member #1: Phone*

Phone

Team Member #1: Number of years with collaboration*

Team Member #1: Ethnicity*

Do you identify as Hispanic or Latina/o/e (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)?

Yes

Prefer not to say

Team Member #1: Race*

How do you identify? Select all that apply:

Team Member #1: Organizational affiliation*

Team Member #1: Title*

Team Member #1: Organizational mailing address*

Team Member #2: Name*

Parent or Community Representative (Strongly Encouraged)

Team Member #2: Collaboration role(s)*

Team Member #2: Email address*

Team Member #2: Phone*

Phone

Team Member #2: Number of years with collaboration*

Team Member #2: Ethnicity*

Do you identify as Hispanic or Latina/o/e (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)?

Yes

Prefer not to say

Team Member #2: Race*

How do you identify? Select all that apply:

Team Member #2: Organizational affiliation*

Team Member #2: Title*

Team Member #2: Organizational mailing address

Team Member #3: Name

Team Member #3: Collaboration role(s)

Team Member #3: Email address

Team Member #3: Phone

Phone

Team Member #3: Number of years with collaboration

Team Member #3: Ethnicity

Do you identify as Hispanic or Latina/o/e (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)?

Yes

Prefer not to say

Team Member #3: Race

How do you identify? Select all that apply:

Team Member #3: Organizational affiliation

Team Member #3: Title

Team Member #3: Organizational mailing address

Team Member #4: Name

Team Member #4: Collaboration role(s)

Team Member #4: Email address

Team Member #4: Phone

Phone

Team Member #4: Number of years with collaboration

Team Member #4: Ethnicity

Do you identify as Hispanic or Latina/o/e (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)?

Yes

Prefer not to say

Team Member #4: Race

How do you identify? Select all that apply:

Team Member #4: Organizational affiliation

Team Member #4: Title

Team Member #4: Organizational mailing address

Team Member #5: Name

Team Member #5: Collaboration role(s)

Team Member #5: Email address

Team Member #5: Phone

Phone

Team Member #5: Number of years with collaboration

Team Member #5: Ethnicity

Do you identify as Hispanic or Latina/o/e (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)?

Yes

Prefer not to say

Team Member #5: Race

How do you identify? Select all that apply:

Team Member #5: Organizational affiliation

Team Member #5: Title

Team Member #5: Organizational mailing address

Collaboration History & Goals

Please provide an overview of your collaboration*

You may want to consider: How long has the collaboration existed? What is the current mission, vision, and/or purpose statement? What is the collaboration’s staffing and funding status? How often does your collaboration meet and is it on a regular basis? What is your collaboration’s governance and decision-making structure? How do you distribute leadership and tasks?

Service populations*

Does your collaboration serve one or more of the priority populations identified by the state of Illinois? If so, which population(s) and how does your work focus on them?

Describe the community your collaboration serves*

You may want to consider: What community or geographic area(s) do you serve? What are the demographics of those area(s)? What are its strengths and assets? What are its challenges and needs?

Engaging diverse perspectives*

Do you engage diverse perspectives (including parents and community members)? If so, how?

You may want to consider: Who are your stakeholders and partners? What do you do to encourage participation and engagement? How do you work with partners to align efforts and work toward a shared vision? How do you engage parents in your collaboration work?

What is your collaboration’s focus area?*

You may want to consider: What is the goal or goals of your collaboration? What issues is your collaboration working to address? What systems-change strategies has your collaboration carried out?

Capacity and readiness to participate*

Participation in the Institute will require your team to complete work between monthly coaching meetings and/or trainings. Describe your collaboration team’s capacity and readiness to participate in the supports offered by CS3.

You may want to consider: How much time will your team commit to spending on Institute work aside from attending trainings and monthly coaching meetings? How will you share the work? How much interest is there to learn additional ways to bring about systems-change?

What are you hoping to gain from this experience?*

You may want to consider: What are some of the challenges you are currently facing that you think CS3 can help you address? What community systems-related skills, strategies, or knowledge does your collaboration want to learn or develop?

Signing & Submitting

By signing and submitting this Request for Supports, you commit to fully participating in all Partner Plan Act Collaboration Institute activities, being a champion for community systems development in Illinois, and contributing to the learning of other collaborations throughout the state. Furthermore, you confirm that you and all the team members listed on this document have the full support of your respective supervisors to dedicate work hours to Institute projects, trainings, and events.

In addition, by signing below you hereby authorize Illinois Action for Children and/or its associates, assistants, or subcontractors to photograph/film. You permit Illinois Action for Children to use and display said photographs/video in any publication, multimedia production, display, advertisement, or World Wide Web (Internet) publication. Illinois Action for Children may use name, likeness, or biographical information supplied. You understand that no compensation is offered in exchange for the images/information. You release and forever discharge Illinois Action for Children, its agents, officers, and employees from any and all claims and demands arising out of or in connection with the use of said photographs/images, including but not limited to, any claims for invasion of privacy or defamation.

Signature of Primary Collaboration Lead*

Names of Team Members*

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