Application for NCSA Co Sponsorship and Financial Assistance for a Cued Speech Camp or Workshop Date received by NCSA: This form and all attachments must be given to Andy Payonk I. Name of Cue Camp or Workshop: Cue Camp Mechuwana II. Amount Requested from NCSA: $3500 III. Contact person: Polly Earl Co director P.O. Box 785 Fort Fairfield, ME 04742 Phone: 207 227 4705 Fax: 207 493 3765 E Mail: mainecues@gmail.com IV. Committee Members/Addresses/Telephone/Email: Angela Laptewicz Co Director angelicas911@yahoo.com (781) 738 6290 Virginia Polly Earl Co Director mainecues@gmail.com (207) 227 4705 Maine Suzanne Flint Activities Coordinator Suzannemarie14@gmail.com (207) 632 7614 New Hampshire Sarina Roffe Treasurer sroffe@cuedspeech.org (917) 439 5126 New York Gela Wax Fuxman, Speech/Language Pathologist gfuxman@cuedspeech.org
(617) 283 1094 Massachusetts Danielle Paquin, Teacher of the Deaf/Hard of Hearing Danielle_joy@sbcglobal.net (860) 573 3045 Connecticut V. Date of Cue Camp/Workshop (DD/MM/YY): August 12 16, 2015 VI. Purpose of Cue Camp / Workshop: To teach beginning Cued Speech classes, provide intermediate and advanced workshops, and provide families and their children with the opportunity to use their chosen method of communication, Cued Speech, or learn the system for the first time, to facilitate communication and language acquisition. To provide families and professionals an opportunity to network with each other in addition to meeting and learning more about expressive and receptive cueing from adult deaf cuers. VII. Co sponsoring organizations: New York Cued Speech Center In discussion of other possible sponsors VIII. Facility (Location) and Contact Information. Camp Mechuwana, Winthrop, ME 207 377 2924 b. Include description of facility accommodations for classes, sleeping, eating, hygiene, recreation: Cue Camp Mechuwana is held at Camp Mechuwana surrounded by 230 acres of woodlands on the shores of Lake Annabessacook and Lower Narrows Pond in Winthrop, Maine. Overnight campers will stay in 8 cabins that sleep 10 people each near the lake. Shared restrooms and showers are in a separate building. Cabins have electricity. Campers will be served family style meals Wednesday dinner through Sunday breakfast (11 meals) in the dining hall. Classes will be held in various buildings near the dining hall. Recreational activities including swimming, boating, volleyball, softball, and crafts will be held in appropriate areas and buildings around the campground. IX. Attach your brochure or tentative schedule of classes, activities, meals, etc. Wednesday: Check-in starting at 3 pm Ice Cream Social 7:00 Thursday: Classes 9:00 3:00 Evening Presentation Friday: Classes 9:00 3:00 Evening Presentation Saturday: Classes 9:00 3:30
Sunday: Alumni Campers BBQ and Dance Departure after breakfast X. Proposed Budget (please include a detailed budget listing all expenditures and expected income): Expenses per Facility Rental person Meals/Snacks $100 Certified Instructors $1,704 Counselors $2,090 Presenters $200 Audiologists SLPs $200 CLTs/ASL Interpreters $2,000 Educational Materials $100 Recreational Materials $300 Printing/Copying donated Postage Telephone donated Advertising Equipment Insurance NCSA Scholarships TBD* Other $6,694 Expected Income NCSA $3,500 Grants $2,000 Donations $1,000 Registration Fees (Net after Facility Fees) $1,500 $8,000 *Any additional funds raised will go towards family scholarships and stipends for additional volunteers if needed. XI. XII. Insurance: We have requested to use NCSA insurance Comments/Special Instructions: none
XIII. By receiving a grant from the NCSA you are thereby accepting these conditions Cue Camp Mechuwana application 2015 X_ Access to Cued Speech/Languages is provided as a mode of communication for the deaf and hard of hearing. (Note: The NCSA will not fund camps/workshops whose philosophy is adverse to the use of Cued Speech/languages). _X Instructors whose NCSA Certification is current will be used for adult classes. (Note: Funding will not be provided for camps or workshops that do not use NCSA certified instructors.) _X Facilitated communication in attendees desired mode will be provided as needed. X Programs will display respect for diverse opinions. _X Health and safety standards will be followed as mandated by state regulations. _X Camp/workshop will require participants to sign photo/video waivers. Waivers must include permission for the NCSA to use photos/videos for promotional materials. Samples provided upon request. A copy of all images will be sent to the NCSA via CD or made available online _X Camp/workshop will be covered by liability insurance. _X Staff and facility will be paid within 60 days. XIV. A report must be sent to the NCSA within 30 days of the close of camp. The report must include: a. A financial report i. detailed description of expenditures and income b. Number of attendees with detail of how many were in each class c. Scholarships awarded i. Number of individuals
ii.states individuals come from iii. Amount awarded d. Program information e. A summary of participants evaluation of the event XV. Return this form along with all supporting documentation by e mail to: Andy Payonk apayonk@cuedspeech.org NCSA Director of Camps and Affiliates Cue Camp Mechuwana application 2015