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SE - 2019-2020 Coach Host-Site Application
Contact / Organization Information
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
(Required.)
Organization Name
Address
Address 2
City/Town
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Country
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2.
Name of Person Filling Out Form
(Required.)
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)?
(Required.)
Name
Title/Role
Email Address
Phone Number
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4.
How did you hear about this Call for Partnerships?
(Required.)
*
5.
Program Information: Mission
(Required.)
*
6.
Program Information: up to 8 sentences describing organization's key programs, accomplishments, and history.
(Required.)
*
7.
How long has the organization been in operation?
(Required.)
*
8.
Top Five Funders:
(Required.)
Funder
Funder
Funder
Funder
Funder
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9.
Organization's annual budget:
(Required.)
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10.
Number of paid staff:
(Required.)
Full time
Part time
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11.
Participant demographics:
(Required.)
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?
(Required.)
Yes
No
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13.
If yes, do you provide a sliding scale or scholarships for participation?
(Required.)
Yes
No
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14.
Are you:
(Required.)
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).
