Youth Activation Committee (YAC)
Please fill out the application for the 2018 - 2019 state YAC by August 31st.
Athlete / Partner Contact Information
Full Name
*
Prefix
First Name
Last Name
Cell Phone
*
-
Area Code
Phone Number
Alt. Phone
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In what role are you are applying for the Youth Activation Committee?
*
Special Olympics Athlete
Peer/Unified Partner
Parent/Guardian Contact Information
Parent / Guardian's Name
*
First Name
Last Name
Relationship to Athlete / Partner
*
Phone
*
-
Area Code
Phone Number
Email
*
example@example.com
General Athlete / Partner Information
How old are you?
*
What grade are you in?
*
What school do you currently attend?
*
If you are applying with a partner, please include the applicant's name
(leave blank if applying on your own)
Are you actively involved in Special Olympics and have a valid Medical Application or Volunteer Form on file?
*
Yes
No
I don't know
Can you travel independently, without parents?
*
Yes
No
In which of these areas do you have skills/talents/training?
Public Speaking
Storytelling
Writing
Planning/Leading
Unified Sports
Coaching
R-Word/RESPECT Advocacy
Club Leadership
Other
What Special Olympics sports and events have you participated in?
What is your favorite Special Olympics memory?
What leadership roles have you held in other school and/or volunteer organizations?
Describe how you have reached out to help others in your community.
Why would you like to join the Youth Activation Committee?
What does inclusion mean to you?
What else would you like us to know about you?
References
Please provide the contact information of two people we can contact for references. One should be a peer and one an adult (non-related).
Peer's Name
*
First Name
Last Name
Relationship to the Applicant
Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Adult's Name
*
First Name
Last Name
Relationship to the Applicant
Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Submit
Should be Empty: