2019 JDRF Youth Ambassador Application
The JDRF Western Wisconsin Chapter is looking for people to join the Youth Ambassador Program! Youth Ambassadors will help the Chapter throughout the year to help “put a face on type 1 diabetes” and help educate the community about what it’s like living with the disease, as well as why supporting JDRF’s mission to cure type 1 diabetes (T1D) is so important. This program is open to individuals who have T1D, are under the age of 18, and are willing to share their personal story!
Please complete this form and return to Jen Allen by Friday, January 18, 2019.
Child's Name *
Your answer
Age *
Your answer
Birthday *
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Date of Diagnosis *
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Parent(s)/Guardian(s) Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email *
Your answer
Phone Number *
Your answer
What do you like to do for fun (hobbies, pastimes, etc.)? *
Your answer
How does living with T1D affect your daily life? *
Your answer
What would a cure for T1D mean to you? *
Your answer
Why do you think you would make a good JDRF Youth Ambassador? *
Your answer
Have you been involved with JDRF in the past? If yes, how have you been involved? *
Your answer
Are you able to attend the 2019 JDRF Spring Gala on Saturday, April 13th (as a volunteer and/or guest)? *
If you have any questions about this application and/or the JDRF Youth Ambassador Program, please contact Jen Allen by phone (608.833.2873) or email (jallen@jdrf.org). Thanks!
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