SADD SPEAKs

Students for Policy, Education,

Advocacy and Knowledge

Program Application

Directions

Please type directly into this document, then save and email your application to . Applications are due by 11:59 pm onMonday, May 9, 2016.

Personal Information

Name: Click here to enter text. Gender: Current Grade in School:

Street Address:Click here to enter text.

City: Click here to enter text.State: Zip Code:

Email: Click here to enter text.Phone: Click here to enter text.

SADD Chapter Information

School Name: Click here to enter text.

School Mailing Address: Click here to enter text.

City: Click here to enter text.State: Zip Code:

SADD Advisor: Click here to enter text.Title (Teacher, Nurse, etc):

Advisor Email: Click here to enter text.Advisor Phone: Click here to enter text.

Social Media Information

Social Media will play a key role in the SPEAKs program. All SPEAKs delegatesare required to have Facebook, Twitter and Instagram accounts as a condition of participating in the program.Parents with concerns can contact Elizabeth Vermette at to discuss further.

Facebook page (on your own page, copy the link at top – for example, facebook.com/jessica.roscoe):

Click here to enter text.

Twitter Handle: Click here to enter text.Instagram Handle: Click here to enter text.

Essay Questions

  1. List your history of involvement with SADD, including on the state level, if applicable. Tell us how many years you’ve been involved, what roles you’ve played in your chapter and on the state level. Be sure to mention any experience you’ve had with government and public policy work on any level of government- federal, state, or local.
  1. Why do you want to participate in SADD SPEAKs? (150 word maximum)
  1. What do you think are the major traffic safety issues facing teens today?
  1. How do you plan to use the advocacy skills that you will learn as part of SPEAKs at the chapter and state level when you return home? (150 word maximum)

SPEAKs Agreement

By signing below, I am pledging the following:

I have the permission of my parent/guardian(s) to apply for the SPEAKs program and have read through the info packet. I understand a parental permission form will be required upon acceptance.

I understand that there will be intense competition for spots in the SPEAKs program. I commit myself to fully participate in the SPEAKs program from May through December, including attending the Washington training this summer, and pledge not to drop out along the way.

I understand that flying on a plane by myself will be the method of travel to Washington, and my parent/guardian(s)and I are comfortable with that (students will be met outside security in Washington and never left unsupervised during the program).

I understand that social media accounts are a required part of the program, and I have set up such accounts if I didn’t already have them.

All the information on this form is honest and accurate to the best of my knowledge.

Type your name here to indicate your acceptance: Click here to enter text.

Supporting Materials

Besides this application, please send a letter of recommendationfor the SADD SPEAKs program from your SADD Advisor- or ask your advisor to send it directly to us by or faxing to 508-481-5759. In the case of any technical difficulties, problems, or questions with this application, please email or call 1-877-SADD-INC for assistance.

Remember, applications and the advisor recommendation must be received by 11:59 pm on:

Monday, May 9, 2016