LEVEL 1 RETREAT APPLICATION
RETREAT DATE: June 20 - 26, 2016
LOCATION OF RETREAT: Wolfeboro, New Hampshire
APPLICATION DUE DATE: April 15, 2016 (EXTENDED DEADLINE)
RETREAT COST: No cost to participant. The retreat cost of $4,500 per girl is paid by Angel Faces donors.
APPLICATION FEE: $100 Application fee (should be raised by applicant herself)
Angel Faces offers the only week-long retreat in the United States for adolescent girls and young women, ages 12-18, with facial differences or large body surface scarring due to burn or trauma-related injuries. Since 2003, Angel Faces has offered these holistic retreats that focus on the psychosocial needs of the attendees. Angel Faces was the first organization to offer this kind of healing retreat, which differs significantly from burn camps.
The Angel Faces Level I retreat offers significant personal attention, so we accept fewer than 20 girls per retreat. Applications are prioritized based on psychosocial needs. Priority is given to girls who have never attended the retreat before. All applications (including returning girls) must include a letter of recommendation from a medical professional. Girls are allowed to attend more than once, depending on their need and space availability. Priority is given to girls who have never attended before.
Angel Faces’ Level I retreat teaches girls how to increase self-confidence and improve their self-image, while embracing their trauma and related disfigurement. Licensed therapists lead sessions on trauma and loss issues followed by methods to facilitate emotional healing. The girls participate in art, journaling and verbal expression. They learn positive self-image through fun practice sessions on how to handle stares, teasing and unwanted questions, goal setting exercises, yoga, and swimming. They also receive private consultations with clinical corrective cosmetic professionals on the application of corrective cosmetics for their specific needs.
The Angel Faces program focuses on the healing process within a holistic framework: mind, heart and spirit are all addressed. The end result for each participant is a renewed sense of hope. Girls leave the Level I retreat with skills and tools to create the life they want, overcoming challenges to reach their full potential. After the retreat, the girls become a part of Angels in Flight, a multi-faceted ongoing support program that reinforces skills and tools acquired during the retreat. A Level II retreat is available for graduates of the Level I retreat (and 18 years or older) who are interested in developing their mentorship and leadership skills.
The Angel Faces nonprofit organization is led by Lesia Cartelli, who endured a serious burn injury as a child. It is supported by two staff members, two licensed psychologists and a dedicated volunteer team of female professionals. Pre- and post-test results show that attendees to Angel Faces retreats experience favorable psychosocial adjustments: Increase in hope; decrease in depressive symptoms; and increase in quality of life. A poster summarizing the 2010 research findings won awards at the American Burn Association conference.
Applications are available for download at www.angelfaces.com. Applications must include a close-up photo of the applicant (which the corrective cosmetics team will use to determine individual needs for the private consult) and a letter of recommendation from a health care provider. Applications also must include a fee of $100, which we hope the girls will raise themselves by babysitting or other work in the community. Having the girl raise the funds demonstrates her engagement and commitment to participate at the retreat and in her healing process.
Angel Faces is a nonprofit that receives donations from individuals, foundations and corporations. Our tax ID number is 20-5718594. Please contact development director Sharon Jones at 760-230-1276 or if you wish to discuss fundraising or sponsoring opportunities.
Send the completed application, a headshot, letter of recommendation, and application fee of $100 to:
Angel Faces
2235 Encinitas Blvd. #107b
Encinitas, CA 92024
Or email:
If you have any questions, please contact us at or (760) 487-1720.
We look forward to receiving your application!
Sincerely,
The Angel Faces Team
lESIA CARTELLI / Terry Hewitt / SHARON JONESFounder/CEO / Program coordinator / DEVELOPMENT DIRECTOR
Voices of Angels – Testimonials
“I have learned so much that helps me and that I will keep with me forever. The retreat was an experience I will never forget. I formed so many relationships and strengthened other ones. I can’t thank you enough.”
“During this retreat, I have learned so much. My heart and eyes have opened to a whole new world. Being at Angel Faces felt like I gained a whole new family. I can’t even describe how much you have already helped me in just one week. It’s insane.”
“In August it’ll be nine years since my injury and every single day is a new experience for me. So thank you for letting this short average-sized Canadian girl experience the wonders of Angel Faces.”
2016 APPLICATION SUMMARY
Participant’s name:Participant’s age (at the time of the retreat):
Submitted by:
Relationship to participant:
Name of referring health care provider:
Phone:
Email:
Application Checklist
Completed and signed application by both participant and parent (including consent form and contract)
Letter of Recommendation from a medical professional
$100 Application Fee
Current close up photo (School photo is acceptable)
Return before April 15, 2016 to:
Angel Faces
2235 Encinitas Blvd. #107b
Encinitas, CA 92024
OR email to:
Retreat Location
Lake Winnipesauke
Wolfeboro, New Hampshire
2016
PARTICIPANT APPLICATION
Part One: Parent/Guardian to complete. You can fill this form out electronically in MS Word by filling in the gray colored areas; move to the different fields by hitting the “tab” key on your keyboard.
Participant InformationParticipant’s Name: / Participant’s Date of Birth:
Participant’s Cell Phone: / Participant’s Age during the retreat:
Participant lives with: / Participant’s Email Address:
Participants’ preferred social media / Participant’s Facebook/Instagram/Twitter Name
Parent/Guardian Information
Name of Parent/Guardian: / Home Phone Number:
2nd Phone Number: / Parent/Guardian Email Address:
Home Address:
2
City: / State: / Zip:2
Name of your Employer: / Position/Title:Employer’s Address: / Employer’s Phone Number:
Does this employer match employee donations to nonprofits?
2
Name of your spouse’s Employer: / Position/Title:Employer’s Address: / Employer’s Phone Number:
Does this employer match employee donations to nonprofits?
2
Emergency Contact InformationEmergency Contact Name: / Relationship:
Home Phone Number: / Cell Phone:
Participant’s Health/Mental Status
(Add a second sheet if needed)
Medications / Dose
1.
2.
3.
4.
Please specify any allergies (food, medication or other):
2
Will your child be in bandages during retreat? If so, please explain/describe. / No Yes:Will your child be wearing pressure garments or splints? (PACK THEM) / No Yes / If yes, how recent:
Wearing schedule:
Does your child have hearing or vision problems? Please explain.
Does your child have any limitations in walking?
Has your child received any
psychological counseling? If so, when?
Therapist name and contact information.
Has your child attended any support groups or camps? / Yes
No
Burn Camp / Location / Date
2
Other Specialty Camps:Who referred you to
Angel Faces?
How does your child handle their facial/body difference socially?
Almost there……..PARENT/GUARDIAN, PLEASE CONTINUE TO COMPLETE THE FOLLOWING:
1. Please explain in detail how your child was injured.
Was the injury a result from abuse? The more we know about the circumstances in the accident, the better we can help her. (Add additional sheet if necessary)
2. What was the date of injury/accident? (month/day/year)
3. How old was your child when she was injured?
4. At what hospital/burn Center was your child treated?
5. Treating physician and phone number:
6. Did your child receive reconstructive surgery?
If so, when was the last surgery? This includes Laser for scars.
7. What percentage of your child’s body was burned?
What areas of her body were affected by the burn/trauma?
8. Does your child have any mobility restrictions? Please explain if necessary.
9. How did your child handle the injury and treatments emotionally? Has her responds changed over time? (Use as much space as you need)
10. Is there currently legal action pending regarding this injury, trauma, or abuse? Are there any depositions pending? Please explain if necessary.
Yoga pant size: Please circle one / S M L XL XXL
Shirt size: Please Circle one / S M L XL XXL
Would your daughter fly to the retreat? (Nearest airport to the retreat is Boston/Logan or Manchester). We will arrange pick up at airport if needed.
Part Two: The participant must complete the following questions.
In order for us to give you an awesome experience, we need to know about you! Please take the time to sit quietly and share with us “who you really are”. Your answers are confidential. So let go, let loose and write away! The more you share with us, the more we can help you! Even if you have attended the retreat before, you MUST fill this form out. Be as detailed as you can.
1. Please give specific reasons why you want to come (or return) to Angel Faces?2. After looking at the Angel Faces website (or experiencing a previous retreat), which topics do you want more information on?
3. What do you find to be the hardest part living with your burn trauma or looking different? Check as many as apply:
Questions from random people / Family response / Making Conversations with strangers or family / Other:
Teasing / Talking to Boys / Socializing / Reactions from children
Stares / Dating (or lack of) / Make-up
Give us a few examples or situations where you felt uncomfortable: (This helps us help you).
4. What % of time each DAY do you do the following?
% of time on Social Media? _____
% of time doing Homework? _____
% of time exercising? _____ What Type? ______If you’re in Team Sports? Which ______
% of time with Family ______With whom? ______
% of time hanging with friends _____
% of time reading _____ What is your favorite book? ______What was the last book you read? ______
OTHER? ______
What are your HOBBIES? ______
Do you work? ______If so where? ______How long have you been there? ______
6. Describe yourself. Use as much space as you need.
I’m super funny when…:
I’m a good friend because…:
When I get angry I…:
I’m happiest when…:
I think I’m good at…:
I get sad when…:
Things that scare me the most are…:
I’m not good at…:
I hate it when…:
7. How would you describe your ability to meet new people?
a. I make friends easily because…:
b. I avoid social situation when: (check all that apply)
There will be new people around / When children are around / Other:
When boys are present / If I need to change clothes (gym or swim class, sleep-overs, etc…)
8. Family and home life:
With whom do you live?
Do you share a bedroom? No Yes (If yes, with whom?)
Do you live sometimes in different places?
How many times have you been away from home alone?
Where is your “safe” place? When do you feel the ‘safest”?
9. If you could change one thing about your life, what would it be?
10. What is your biggest concern for your future?
11. What do you wish you were better at?
12. Who do you admire most? Why?
13. What type of career are you thinking about getting into?
Additional Comments: Use this space for other information you would like to share.
MORE… DON’T FORGET TO HAVE YOU PARENTS SIGN THE WAIVER, CONSENT FORM, AND CONTRACT!!
Part three: Returning participants must complete the following questions.
Because this is a specialized retreat where significant personal attention is given to each participant, we only accept a limited number of girls per retreat with preference given to first-time attendees; Your answers to these questions will help determine whether you will be asked to attend the 2016 retreat if there is space. If we run out of space in the program prior to your acceptance, we will add your name to the waitlist. Please note that if you are added to the waitlist, you may be given short notice before the retreat that a spot has opened up for you. The deadline for submitting applications is April 15, 2016.
1) How many times have you attended an Angel Faces® retreat? What years did attend?2) How old were you when you attended the retreat(s)?
3) How many years (or months) after your accident did you first attend?
4) What did you gain from the last retreat? How did it help you?
5) Have you stayed in contact with any girls you met at the retreat? If yes, how do you communicate? How often do you communicate?
6) What tools, skills did you learn at the retreat?
7) What changes have you made in your life since attending Angel Faces?
8) What areas in your life do you need more help with? How do you think the retreat can help?
Media Release
To be read and signed by parent/legal guardian and participant
Dear Parents/Guardian and Participant,
The continued success of Angel Faces relies heavily upon the ability to sustain funding. In order to continue and expand the program, maintain and seek new supporters, we must share our vision in a variety of ways. This includes but is not limited to; video presentations slide shows, newspaper or magazine articles, descriptive brochures, television or radio programs, and photographs.
You are not required to give permission for publicity release. We do, however, request that you sign for permission to involve your child in publicity opportunities should the occasion present itself during the retreat or while representing Angel Faces. We strongly encourage you to have a discussion with your daughter regarding this agreement and her feelings about being photographed. We will only consider the agreement valid if the participant has signed as well as the parent/guardian. Angel Faces facilitators will monitor media and printed materials to the best of our ability to encourage appropriate representation of the retreat participants.
Sincerely,
The Angel Faces Team