Request edit access
YICU Application Form
Thank you for your interest in applying for the YICU service award. The YICU Service Award recognizes young adults, ages 12 through 22, who have demonstrated commitment to community service and leadership. Please carefully follow the instructions provided so that your application is complete when returned to us. All applications must be completed online.

Submit your completed application and one reference to the YICU Service Award Steering Committee no later than June 15, 2019. After June 15, all applications will be screened. You will be contacted by August 15, regarding the next steps. For additional information about YICU, please access the following link -

Please take a few minutes to complete this form carefully. The decision to pick the winners will be made SOLELY based on the information from the application, nomination and reference forms.

By sharing the name and email of your parent/guardian in the form below, you ("Applicant") affirm that you have received their approval to grant For A Better Tomorrow (“FBT”), Why I See You ("YICU") service awards, and their agents the right and permission to use photographic portraits, pictures, digital images or videotapes of the applicant, or in which the applicant may be included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but not limited to use in any FBT or YICU publication or on the FBT website, without payment or any other consideration.

You can edit/update your responses as many times as you prefer, after your initial submission. You will receive a link to "Edit your response" directly after submitting, in the confirmation page. You can bookmark that link for later access. Alternatively, you can edit the form through the confirmation email that you will receive after submitting your form.

If we can be of further assistance, please email us at

Best regards,
YICU Service Award Steering Committee

Email address *
Name *
Please share your first name and last name
Parent/Guardian's Name *
Please share first name and last name
Parent/Guardian's Email *
Gender *
Age *
Educational Institution Attended *
Please share current or last School/College you attended
Address *
Please share your residential address.
Phone Number *
This information would only be used if the steering committee is unable to reach you via email.
Parent or Guardian's Name *
Parent or Guardian's Email *
Parent or Guardian's Phone *
This information would only be used if the steering committee is unable to reach you via email.
Non-profit Beneficiary *
FBT will make a $250 donation towards a non-profit in honor of the nine award winners. If you were chosen as the award winner, could you pre-select a non-profit from the following list? You are welcome to suggest a non-religious and apolitical non-profit for YICU's consideration.
Meal Preference *
All nominees will be invited to the event as our special guest and your ticket has already been paid for. Please confirm your attendance and let us know if you have any special dietary needs.
Exclusive Event for Nominees *
We invite you to an exclusive event on August 17 from 2:00 - 4:00 pm at to meet and interact with your fellow nominees to continue to build a sense of our community. Please RSVP if you can attend this event.
Portrait Picture *
We would like to publish a portrait picture of yours in the program booklet. Please upload a high resolution portrait picture of yourself.
Video Introduction
Optional Request: We would like to receive a 30 second intro video that help us learn about who you are and what you are passionate about.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service