Youth Application Form

The 84 Movement wants to honor a youth leader from Massachusetts!  
 
The 84 Movement’s Statewide Youth Leadership Award is a chance for you to BE RECOGNIZED for the great work you do in your community and in the state! 

AWARDEE WILL RECEIVE: 
  • Recognition at The 84's Kick Butts Day: Youth Day of Action event on Thursday, March 30, 2023 with the chance to deliver a 3-5 minute speech  
  • Recognition on The84.org and other social media (photo and profile will be posted) 
  • A scholarship of $500 
  • Potential press coverage and recognition by legislators in your district 
     
BASIC ELIGIBILITY – Any young person who: 
  • Is a Massachusetts resident 
  • Is between 10-19 years old AND in grades 5-12 
  • Has been active in their Chapter since at least March 2022 (if not longer!) 
     
HOW DO I APPLY? 
  • Fill out the application form and answer ALL the questions 
  • Have your adult advisor (or another adult familiar with your advocacy work) complete the nomination form 
  • Send forms in by 11:59pm on Wednesday, March 1, 2023 
     
AND THEN WHAT?  
  • You will be notified by Wednesday, March 15, 2022 if you have been selected. 
  • Join The 84 for Kick Butts Day: Youth Day of Action on March 30, 2023 to continue raising awareness and to celebrate your hard work in The 84 Movement! 
     
For questions and more information, feel free contact Amanda Irizarry at airizarry@hria.org 
Due by 11:59pm EST on March 1, 2023

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* 1. Name of applicant:

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* 2. Grade:

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* 3. Date of birth:

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* 4. Pronouns:

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* 5. What year did you begin working in tobacco prevention? 

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* 6. Will you attend Kick Butts Day: Youth Day of Action 2023 where the winners will be honored?

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* 7. Address:

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* 8. City:

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* 9. Zip Code:

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* 10. Email:

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* 11. Phone:

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* 12. School/Organization:

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* 13. 84 Chapter Name:

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* 14. Name of adult who will be completing your nomination form:

ABOUT YOUR COMMUNITY ADVOCACY WORK: Please give specific, concrete examples whenever possible (250 word maximum) 

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* 15. What are you doing to address important issues and how does it contribute to supporting your school, neighborhood, and/or community? 

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* 16. What is your personal connection to the work of the 84 Movement?

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* 17. What does leadership mean to you? Is there anything else you would like to share with us about your leadership skills and experience?

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* 18. What challenges arose for you this past year? How did you overcome them?

Your responses will be evaluated by the selection committee(s) on the following: 
  • Were your responses clearly written? 
  • Did you demonstrate leadership in your community and/or statewide? 
  • Did you give concrete examples where applicable? 
  • Did you show an understanding of advocacy/community organizing?

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