Special Olympics Arizona Program Application 2023-2024

Special Olympics Arizona Program Application 2023-2024

Thank you for taking the time to complete this program application to participate in Special Olympics Arizona competitions, programs, and activities.

"Special Olympics Arizona takes the safety of our athletes, volunteers and staff as the highest priority. We will follow the guidelines from the State and local Health Authorities regarding resuming in person sports and will adjust our operations as needed. In addition, any other guidelines set forth by the host program will also be considered in keeping our community safe. Please fill out this Program Application whether you are ready to participate or considering participation in the future."

Unified Champion Schools Contacts:

Unified Champion Schools Senior Coordinator: Payton Bergmann | Payton@SpecialOlympicsArizona.org

Unified Sports Manager High School (AIA):

Thomas Miranda | Thomas@SpecialOlympicsArizona.org

Area Directors:

River Area Manager: Mandy Evans | Mandy@SpecialOlympicsArizona.org

Yuma Manager: Mary Nielsen | Mnielsen@SpecialOlympicsArizona.org

Mountain & Northern Monument Area Director: Rubett Garcia | Rubett@SpecialOlympicsArizona.org

Four Peaks & Southern Monument Area Manager: Nick Dinsmore | Ndinsmore@SpecialOlympicsArizona.org

Palo Verde Area Manager: Sean Williams | Sean@SpecialOlympicsArizona.org

Coronado Area Manager: Sean Whitley | Whitley@SpecialOlympicsArizona.org

Contact Information

Please submit the information for the main contacts for your program.

First Name*

Last Name*

Phone Number*

Phone

Email Address*

Role Type for Secondary Contact*

Head of Delegation

Coach/Educator

Secondary Contact First Name*

Secondary Contact Last Name*

Secondary Contact Phone Number*

Phone

Secondary Contact Email*

Program Area*

What area does your program fall under?

River Area 1: Yuma, Lake Havasu, Kingman, Bullhead City and surrounding cities

Mountain Area 2: Flagstaff, Prescott, Prescott Valley, Chino Valley, Sedona, Verde Valley, Page, and surrounding cities

Monument Area 3: Clifton, Globe, Holbrook, Show Low, Springerville, Safford, Navajo Nation and surrounding cities

Palo Verde Area 4: Avondale, Glendale, Goodyear, Peoria, Phoenix, Surprise, and surrounding west valley cities

Four Peaks Area 5: Mesa, Tempe, Scottsdale, Gilbert, Florence, and surrounding east valley cities

Coronado Area 6: Casa Grande, Douglas, Eloy, Marana, Nogales, Sierra Vista, Tucson, Vail and surrounding southern cities

Program Type*

Community Program: not affiliated with a school or district

School Program: includes district wide programs

School Program: Choose*

You may choose more than one if it applies to your school program.

School Program: Name*

School Program: District*

School Program: Address*

School Program: Mailing Address*

If we cannot mail to your school, please put in the PO box or District mailing address, THIS IS IMPORTANT - PLEASE put the correct information or N/A

School Program: Population*

Please estimate the total student body if you are unsure.

School Program: Participation*

First Year Program

Returning Program

School Program: Returning Program*

Please enter the number of years your program has participated.

School Program: Model*

Traditional Sports: Engaging people with intellectual disabilities only.

Unified Sports: Engaging people with and without intellectual disabilities, partners and athletes.

BOTH: Program participates in both Traditional and Unified Sports.

School Program: Instagram

Does your program have an Instagram account dedicated to your activities? If yes, please provide the Instagram Name/handle below.

Unified Champion School Reporting Requirements

As the liaison for your Unified Champion School program, please read the statements below and agree to complete the following:

School Program: Reporting Requirements*

You are aware that the UCS school liaison will receive 3 reports per year

1 Midterm report, 1 Final Report, 1 Liaison Survey

It is MANDATORY that these reports are completed to be eligible for program funding.

As UCS school liaison, I will complete the 3 reports for UCS staff - PLEASE DO THIS! It affects our grant funding if you do not. UCS staff will email for reporting numbers EVERY YEAR!

School Program: Reporting Requirments*

You acknowledge that should your UCS liaison not complete these surveys, it may impact your school’s eligibility to receive funding for your school’s UCS program from SOAZ.

I confirm, as UCS Liaison, my schools funding could be impacted by not completing the Fall and Summer surveys

School Programs: Nationally Recognized*

Are you a Nationally Recognized Banner Unified Champion School?

Yes

School Program: Banner Type

Renewed Banner Program

First Time Banner Program

School Program: Banner Status

What year did you receive your the National Banner recognition?

Program Participation: Activities

Schools Program: Activities*

Please select what activities your program is interested in for the 2023-2024 school year.

Sport: Traditional/Unified

Esports: Traditional/Unified

Unified Ukulele: Training during Fall season and program implementation in Spring

Unified Sports Adaptive PE Resource

Unified Sports through Arizona Interscholastic Association (AIA) *High School ONLY*

Fundraising event: ex. Polar Plunge / Minute That Matters Fundraiser (60-second fundraiser)

Youth Summit / Fan Activation

Other Unified Activities (i.e. inclusive dance, inclusive theater, hosting a dance or pep assembly) engaging ALL students and more – please specify below:

School Program: Unified PE*

If you have Unified PE, could you provide the estimated or actual student number?

Please put 0 if you do not have a Unified PE class.

Inclusive Youth Leadership

Inclusive youth leadership is when young people of all abilities are given opportunities to be leaders in their schools and communities. These leadership activities help students find their voices and teach them to become change agents in their communities by promoting equality and acceptance.

School Program: Unified Club*

Does your school currently have a Unified Club or interested in starting one during the 2022-2023 season?

This includes any type of club that promotes socially inclusive activities (applies to Best Buddies and any other inclusive campus club)

Yes, we have a Unified Club

No, but I would like to learn more

No, I am not interested

School Program: Athlete Participants*

Please estimate how many athletes (individual with an intellectual disability) will participate in your Unified Club during the 2023-24 season? (applies to Best Buddies and any other inclusive campus club).

School Program: Unified Partner Participants*

Please estimate how many Unified partners (individual without an intellectual disability) will participate in your Unified Club during the 2023-24 season? (applies to Best Buddies and any other inclusive campus club).

Community Program Information

Community Program: Delegation Name*

Community Program: Address*

Community Program: Mailing Address*

Community Program: Model*

Traditional Sports: Engaging people with intellectual disabilities only

Unified Sports: Engaging people with and without intellectual disabilities

BOTH: Program participates in both Traditional SO Sports and Unified Sports

Community Program: Age Range*

What age ranges does your program provide for?

Community Program: Accepting New Members?*

Yes

Other, please fill out below.

Community Program: Other*

Young Athletes: Ages 2-7

Young Athletes is an early introduction resource to sports and the world of Special Olympics for those with and without intellectual disabilities (ID). Open to Community and School programs as well as tons of resources for parents to participate in the home!

Young Athletes: Interest*

Yes, I am interested in learning more.

No. I am not interested in Young Athletes.

Yes, I currently participate in Young Athletes.

Young Athletes: Number of Participants with ID*

# of Special Education Students (those with Intellectual and Developmental Disabilities) who will participate in Young Athletes: if you are unsure, please estimate.

Young Athletes: Number of Participants WITHOUT ID*

# of General Education Students (those without IDD) who will participate in Young Athletes: if you are unsure, please estimate

Young Athletes: Participation*

Are you a Community / School program that is ONLY participating in the Young Athletes program?

Select

PROGRAM PARTICIPATION: SPORTS (OPEN to ALL PROGRAM TYPES)

Please select what sports your program is interested in for the 2023-2024 year.

Participation: Sports for Athletes*

Estimate total athletes (individual with an intellectual disability) that will participate in Unified sports during the 2023-24?

Participation: Sports for Unified Partners*

Estimate how many total partners (individual without an intellectual disability) that will participate in Unified sports during the 2023-24?

Program Participation: Activities

Please select what activities your program is interested in for the 2023-2024 year.

Activities*

Spread the Word: Inclusion Campaign (formerly known as the “R-Word Campaign”) (*Unified Schools must complete the mid-term survey (Emailed in November) to receive a free inclusion kit)

Unified Fan Activation Mobile Unit – SOAZ branded equipment and lunch time activity, corn hole, music, hula hoops and more!

Community-based events

Unified Field Day/ Sports Expo

Healthy LEAP into Fitness (Health Education)

Not Applicable

Additional Program Initiaves*

We would love to hear more about your program’s initiatives and how we can support you! Please provide a brief description of fun activities, events, fundraisers, social media campaigns/groups/clubs, or other creative ideas you might have during the year!

Special Olympics Arizona Program Agreements & Consents

E-Newsletter & Event Information*

I consent to receive the Special Olympics Arizona e-newsletter and event information.

Yes

Area & State Event Information*

I would like to receive information on Special Olympics Arizona area events.

Yes

SOAZconnected Information*

I would like to receive information on SOAZconnected, designed to promote the physical, emotional, and social well-being of our community through interactive, web-based engagement opportunities.

Yes

Program Agreement & Failure to Comply*

This program will follow, to the best of its ability, the rules and regulations of Special Olympics Inc. and Special Olympics Arizona, including but not limited to:

-Enrollment of all Athletes and Partners (a current Athlete/Partner Medical Release & Consent Form on file with Head of Delegation and SOAZ State Office for each Athlete/Partner).

-Coaches for this delegation will have copies of each Athlete/Partner Medical Release & Consent Form in their possession at all practices, competitions, and other events.

-I have reviewed the SOAZ Volunteer Application, Screening, and Training Policy and the SOAZ Coaches’ Certification Policy.

-All Coaches for this delegation have met (or will meet before holding their first practice) the certification requirements outlined in the current SOAZ Volunteer Application, Screening, and Training Policy and the SOAZ Coaches’ Certification Policy.

-Registration of all Volunteers (current Volunteer application forms on file/approved).

-I will abide by Article 1 of the Special Olympics International Official General Rules.

-Oversight of Special Olympics Code of Conduct on all Volunteers, Athletes, Partners, and parents.

-Adherence to all SOAZ fundraising policies/procedures with respect to all funds raised in the name of SOAZ.

-I will adhere to all SOAZ accounting procedures with respect to funds raised and spent in the name of Special Olympics, including cash advances, reimbursement requests, purchase orders, credit card expenses, etc.

-Refraining from entering into any written agreement (contracts) without approval from area/state SOAZ offices.

-Refraining from opening any school or bank accounts for this delegation.

-Attendance at all required meetings, training's, opening ceremonies, and conferences.

-I certify the information provided on this Program Application is correct and true

-I will contact Special Olympics Arizona whenever program information changes or updates need to be made

-I understand all athletes participating in Special Olympics must pass a sport physical. Partners under the age of 18 must complete a Unified partner form (SOAZ form). All other partners must complete all Class A Volunteer requirements.

-This local program understands that failure to follow these agreements may result in immediate suspension of rights to conduct the Special Olympics program.

-Under these conditions, I request accreditation as a local program under the supervision of Special Olympics Arizona.

I agree to the rules & regulations of Special Olympic Inc. and Special Olympics Arizona

I don't agree to the rules & regulations. I understand my program application, including funding, will not be approved till further follow up with SOAZ staff.

Send me a copy of my responses

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