Southern US - 2020-2021 Coach Host-Site Application

Contact / Organization Information

Southern US 2020-2021 Program Year

Before filling out application, please ensure you understand the details of the Up2Us Coach program. Located here!

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* 1. Organization Contact Information

Organization Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

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* 2. Name of Person Filling Out Form

Name

Title/Role

Email Address

Phone Number

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* 3. Who will serve as Host Site Supervisor (this is the person who will oversee and directly supervise your coach/es)?

Name

Title/Role

Email Address

Phone Number

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* 4. How did you hear about this Call for Partnerships?

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* 5. Program Information: Mission

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* 6. Program Information: up to 8 sentences describing organization's key programs, accomplishments, and history.

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* 7. How long has the organization been in operation?

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* 8. Top Five Funders:

Funder

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* 9. Organization's annual budget:

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* 10. Number of paid staff:

Full time

Part time

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* 11. Participant demographics:

Percentage of youth served who have physical and/or mental disabilities.

Percentage of youth served who qualify for free/reduced price lunch programs.

Gender breakdown of youth served (example: 45% female, 53% male, 2% other).

Age range of youth served.

Number of youth served across all programing activities.

Percentage of youth served who are youth of color.

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* 12. Does your organization require a fee for youth participation?

Yes

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* 13. If yes, do you provide a sliding scale or scholarships for participation?

Yes

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* 14. Are you:

A first-time host site (applying for coaches for the first time or have never been awarded coaches before).

A current or previous host site (have applied for and been awarded Up2Us Sports coaches in the past).