2019 Youth Advocate of the Year Award
This application is for Reality Check youth members interested in becoming the 2019 Youth Advocate of the Year. One youth advocate will be selected to represent each of the four regions; Western, Central, Capital, MERO as a regional Youth Advocate of the Year. And one youth will be awarded the State Youth Advocate of the Year.
Applicants Full Name *
Address *
City *
County *
Region *
Home Phone *
Cell Phone *
Email *
Name of School *
Year in School *
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 Advocate of the Year program and also to complete confidential or anonymous surveys and participate in interviews for evaluation purposes.
Signature *
Youth Photo and Video Statement
Your uploaded photo will be used on the web and at the YAYA ceremony. Each applicant will submit a 1-3 minute video. Each video MUST begin with the following statement, "My name is _______ and to me, being the Youth Advocate of the Year means..." Please submit either your direct video OR the link to your video on YouTube ONLY.
Photo Submission *
Required
Video Submission
Video Submission Link
Participant Signature *
Get link
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service