2020 Youth Ambassador of the Year Award
This application is for Reality Check youth members interested in becoming the 2020 Youth Ambassador of the Year. One youth will be selected to represent each of the four regions; Western, Central, Capital, MARO as a regional Youth Ambassador. And one youth will be awarded the New York State Youth Ambassador of the Year.

Applicants Full Name *
Address *
City *
County *
Region *
Home Phone *
Cell Phone *
Email *
Name of School *
Current Age *
Parent or Guardian Information
Guardian 1 Full Name *
Address *
City *
Email *
Home Phone *
Cell Phone *
Guardian 2 Full Name
Address
City
Email
Home Phone
Cell Phone
Written Statements
Each applicant will submit a series of written statements (up to 750 words each) describing their experiences in each of these areas. We highly recommend that applicants first write their statements in a word processing program and then copy and paste their work into the form, because there is no save button for partially completed work.
Advocacy *
Taking Initiative & Impact of Activities *
Leadership *
Creative Thinking & Problem Solving *
Coordinator Reference *
Photo Release, to be completed by Parent or Guardian
I grant permission for my child to appear in person or in voice, video, or photographic presentation for radio, television, websites, or print media reports and/or media campaigns resulting from participation in the Youth Ambassador of the Year program.
Signature *
Youth Photo and Video Statement
Youth must submit a current head shot photo of themselves to be utilized in YAYA award ceremony and promotions.
Photo Submission *
Add file
Required
Video Submission
Add file
Video Submission Link
Participant Signature *
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