Parent/Family Leader self-Nomination Form for FRIENDS PAC

This form is completed by the parent/family leader seeking to serve on the FRIENDS National Center for Community Based Child Abuse Prevention PAC. Nominations must be submitted by October 31, 2025.

FRIENDS is seeking nominations of parent/family members who are willing to share their experiences with prevention services and parent voice as a representative on the FRIENDS’ PAC. Parents/family members may self-nominate or be recommended by a CBCAP State Lead Agency, Tribal or Migrant program or local child abuse prevention program. Nominations will be open from October 1 – October 31, 2025. For additional selection criteria, please refer to the Call for Nominations. Direct questions about the nomination process to MaryJo Alimena Caruso at (724)591 5448 or mjcaruso@friendsnrc.org . To learn more about FRIENDS and the FRIENDS PAC, visit www.friendsnrc.org.

Submission Instructions: Parent/family leaders should provide their nomination information using the following link: https://friendsnrc.org/friends-pac-parent-nomination/ or completing the Parent Family Leader Self Nomination Form FRIENDS PAC 2025 and emailing it to mjcaruso@friendsnrc.org. This form must be completed by the parent/family leader even if the parent is recommended by an organization*. All submissions are due by 10/31/25.

*CBCAP State Lead Agency, family strengthening/child abuse prevention program or community organizations (if applicable), must complete and submit the separate Organization Recommendation available at https://friendsnrc.org/friends_pac_organization_nomination/.

Name

Your complete address

City

State

Zip Code

Cell Phone Number(s)

1. Please provide the age(s) in years of the children you are currently raising:

Total number of children:

2. Describe your participant experience and parent/family member perspective in a community-based family strengthening or child abuse prevention program, parent education, kinship care, home visiting, or (if applicable) the nominating organization?

3. How long have you participated as parent/family leader and what role(s) have you held within community, faith or family strengthening organizations?

4. FRIENDS is seeking parent/family caregivers who have participant knowledge or experience related to one or more of the purposes or requirements of the CBCAP program. Please check any that apply to you:

Participating in activities and services that support families and prevent child abuse and neglect Receiving services and resources to support my family (e.g., voluntary home visiting, respite services, etc.) Receiving support for needs of families with children with disabilities (e.g., respite care) Providing leadership in the planning, implementation, and evaluation of prevention programs and policy decisions Promoting public information in their community or state to increase awareness on child abuse and neglect prevention Contributing training and technical assistance activities for child abuse prevention programs

5. What are your priorities for children and families (for your own children as well as the children in your community)?

6. How has your participation with a local or community prevention organization (such as the Community Based Child Abuse Prevention State Lead Agency, Family Strengthening program or a Partner Agency) changed the lives of you, your children, or family?

7. Please describe any parent leadership roles you have held, including experiences as an advocate for change, within your community or state.

8. Please list your experience in providing training, journalism / newsletter development, speaking with the media or participating in any other public events.

9. Why do you want to serve as a parent/family leader on FRIENDS NC for CBCAP Parent Advisory Council (PAC)?

10. Will you commit to participating in monthly virtual (Zoom) Council meetings that last approximately 1.5 hours on the second Thursday of the month @ 6:30 pm ET and participate in additional virtual workgroup opportunities?

11. Do you have daily access to a computer, printer, the internet, and email?

12. Are you able to travel independently by airplane once per year to the in person PAC Retreat and Annual CBCAP Grantees Meeting? (Travel arrangements and expenses are provided by FRIENDS. Pre-approved minor expenses will be reimbursed to the PAC member by FRIENDS after travel is completed.)

13. What else would you like the FRIENDS PAC to know about you at this time?

Parent/Family Leader self-Nomination Form for FRIENDS PAC

This form is completed by the parent/family leader seeking to serve on the FRIENDS National Center for Community Based Child Abuse Prevention PAC. Nominations must be submitted by October 31, 2025.

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