BroncoBOLD Idaho High School Ambassador Application

To open the PDF in a separate window (suggested), please click on the upper right hand corner (the box with the diagonal arrow pointing to the right):

Today's Date:

Date

Name of High School:

School District:

Street Address of High School:

City:

Zip Code:

Full Name of Student Completing Form:

First NameLast Name

Age of Student Completing Form:

How old are you?

Date of Birth:

Date

Student Grade During the 2023/24 Academic Year:

What grade will you be in for the 2023/24 academic year?

Please select the interscholastic activity you will participate in for your high school during the 2023/24 academic year. If you participate in more than one, please select all that apply.

Student Email Address:

example@example.com

Student Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

1. Student Leadership Committee Member #1

First NameLast Name

Date of Birth:

Date

Email:

example@example.com

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Grade During 2023/24:

What grade will this committee member be in for the 2023/24 academic year?

Please select the interscholastic activity you will participate in for your high school during the 2023/24 academic year. If you participate in more than one, please select all that apply.

2. Student-Athlete Leadership Committee Member #2

First NameLast Name

Date of Birth:

Date

Email:

example@example.com

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Grade During 2023/24:

What grade will this committee member be in for the 2023/24 academic year?

Please select the interscholastic activity you will participate in for your high school during the 2023/24 academic year. If you participate in more than one, please select all that apply.

3. Student-Athlete Leadership Committee Member #3

First NameLast Name

Date of Birth:

Date

Email:

example@example.com

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Grade During 2023/24:

What grade will this committee member be in for the 2023/24 academic year?

Please select the interscholastic activity you will participate in for your high school during the 2023/24 academic year. If you participate in more than one, please select all that apply.

4. Student-Athlete Leadership Committee Member #4

First NameLast Name

Date of Birth:

Date

Email:

example@example.com

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Grade:

What grade will this committee member be in for the 2023/24 academic year?

Please select the interscholastic activity you will participate in for your high school during the 2023/24 academic year. If you participate in more than one, please select all that apply.

1. On-Site Advisor #1 (Counseling Office Representative):

First NameLast Name

Position:

What position does this advisor hold at the high school?

Email:

example@example.com

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

2. On-Site Advisor #2 (activities director, teacher, certified athletic trainer, etc.):

First NameLast Name

Position:

What position does this advisor hold at the high school?

Email:

example@example.com

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

1. Please describe any current mental health programming at your school for student-athletes. If you do not have any mental health programming specific to student-athletes, please write "N/A" in the blank below:

2. After reading through the program description in its entirety, please name two things you intend to accomplish during the first year of the BroncoBOLD High School Ambassador program? Be specific and state why accomplishing these two items are important to you and your school.

3. If chosen to be a BroncoBOLD High School Ambassador school, how do you intend to engage (a) your student-body and (b) the greater community in mental health awareness and advocacy?

4. Review the list below. Which of these areas are needs for your school? Please prioritize your school's needs by checking "very important," "important," "somewhat important," or "not important" for each item listed below. (student-athlete mental health education, learning signs and symptoms of mental health conditions, how to help a teammate or friend, mental health education for coaches, BroncoBOLD assembly, Suicide Prevention Week programming around athletics, etc.):

Rows	Not Important	Somewhat Important	Important	Very Important
General student-athlete mental health education
Learning signs and symptoms of mental health conditions
Learning how to help a friend or teammate in need
Mental health education for coaches and staff
BroncoBOLD assembly brought to your school for the entire student-body
Suicide Prevention Week programming around athletic events
Mental Health Awareness programming around athletic events
Learning how to develop your school's very own student-athlete mental health initiative
Take part in BroncoBOLD events on Boise State's campus and in the community (community outreach)

Are there any other areas not listed, but have been identified as important mental health programming needs at your high school? If so, please list below:

By applying for the BroncoBOLD High School Ambassador program, I (we) acknowledge that: (1) I (we) have read the BroncoBOLD High School Ambassador Program Application Manual in its entirety (located above in "Step One" of this document), and (2) if selected, the following must be fulfilled during the 2023/24 academic year:

The application to nominate your school must be completed by a currently enrolled student-athlete attending your high school full-time. Applications open at 9:00am MST on April 27, 2023 and close at 5:00pm MST on May 22, 2023.

The application requires each school to list four additional student-athletes (the student-athlete completing the form (you) makes five total) who will serve on your high school’s BroncoBOLD High School Ambassador Leadership Committee.

At least two on-site faculty advisors are required for each school. One MUST be a school counselor, psychologist or social worker at your high school. The second on-site faculty advisor MUST be a current staff member employed at your high school (activities director, teacher, certified athletic trainer, etc.).

The BroncoBOLD High School Ambassador Leadership Committee and at least one of the on-site faculty advisors from each school selected will be required to attend the BroncoBOLD High School Ambassador Leadership Mental Health Summit in late August 2023 (date to be announced in June 2023) to kick-off the BroncoBOLD High School Ambassador Program. The event will be held on Boise State’s campus and mental health education will be delivered to student leaders, along with time spent in collaboration with others to develop each high school’s vision for their own mental health initiative. Although instruction hours will be considered, a portion of the Summit may be held during school hours and may require schools to excuse student-athlete leaders and on-site advisors to attend the training.

Each BroncoBOLD Ambassador High School will have the opportunity to send select staff members to a certification training in Teen Mental Health First Aid (TMHFA) (up to 24 staff members total for each high school over the course of three trainings). TMHFA trainings will be offered on Boise State’s campus in August, November and February (final dates to be announced in June 2023) by Boise State Athletics’ staff members who are certified TMHFA instructors. Each high school will be able to select up to 8 staff members of their choosing (teachers, coaches, administrators, custodial staff, etc.) to attend each training. BroncoBOLD Ambassador High Schools located more than 75 miles from Boise State’s campus can complete the certification virtually. Each training will have a maximum capacity of 32 individuals (eight individuals from each of the four BroncoBOLD Ambassador High schools).

The BroncoBOLD High School Ambassador Leadership Committee must be able to dedicate 1-2 hours/week to growing the movement in your school and community.

Starting in August, and throughout the academic year, the BroncoBOLD High School Ambassador Leadership Committee must hold at least one Leadership Committee meeting per month on your high school’s campus. At least one of the on-site faculty advisors must be present at each meeting. To encourage attendance at these meetings, it is strongly encouraged to have an attendance policy in place for the Leadership Committee members (i.e., one absence allowed during the school year).

The BroncoBOLD High School Ambassador Leadership Committee will lead one fundraising activity per academic year to bring awareness to mental health and raise funds for your high school’s initiative.

The BroncoBOLD High School Ambassador Leadership Committee and at least one of the two on-site advisors, will be required to attend two calls—one in the fall semester and one in the spring semester—to connect with other BroncoBOLD Ambassador high schools around the state.

Signature of Student-Athlete completing the application:

Date and Time Stamp:

Signature of On-Site Faculty Advisor #1:

Date and Time Stamp:

Signature of On-Site Faculty Advisor #2:

DateTime

BroncoBOLD Idaho High School Ambassador Application

Welcome to the online application for the 2023/24 BroncoBOLD Idaho High School Ambassador program! We are excited you are here to learn more about our inaugural program for student-athletes and their schools. Please follow the steps below to submit your application by 5:00pm on May 22, 2023!

Step One:

Step Two:

I. Basic Information

II. Committee Information:

III. On-Site Advisors

IV. Reflection Questions

V. Acknowledgment of Program Application Details

THANK YOU for your application and desire to be advocates for mental health in your school and community!

In the meantime, before you click on submit, check out our BroncoBOLD slide show to see some of the cool things we've been up to over the years and meet Jett, Boise State Athletic's Official Sports Therapy Dog!