UCS Partnership Agreement

General Information

School District*

School Name*

County*

Select

Enrollment #

School Campus: Mailing Address*

Address, City, State and Zip code

School Campus: Physical Address*

Address, City, State and Zip code

School Campus: Phone*

Point Of Contacts

Primary Liaison (Head of Delegation)

Name: Primary Liaison*

Email: Primary Liaison*

Phone: Primary Liaison*

Phone

Job Title: Primary Liaison*

T-shirt size

Select or enter value

Leadership Team

Name: Athlete*

Email: Athlete

Name: Unified Partner*

Email: Unified Partner

Leadership Team: 2nd Contact Name*

Leadership Team: 2nd Contact Email*

Unified/Inclusive PE Teacher

Name: Coach/PE Contact*

Email : Coach/PE Contact*

Phone: Coach/PE Contact

Phone

Athletic Director

Name: Athletic Director*

Email: Athletic Director*

Phone: Athletic Director

Phone

School Resource Officer/SRO

Name: Resource Officer/SRO*

Email: Resource Officer/SRO*

Phone: Resource Officer/SRO

Phone

Unified Champion Schools Core Components

To be eligible for start-up funding, a school must commit to implementing each of the 3 core UCS Components (Unified Sports/Activities, Inclusive Youth Leadership, and Whole School Engagement).

UCS Inclusive Youth Leadership Component*

Conduct Young Athletes for students 2-7 years old at your Elementary School

Unified School Youth Activation Committee (YAC)

Unified Club

Unified Pair on Student Council

State YAC - Youth Activation Committee

Other

Whole School Engagement: Other

Communication and Training*

*Provide SOAR with monthly highlights, updates, pictures and/or videos of campus activities.

*Complete online Liaison survey from UMass (April-May)

*Provide SOAR with a midterm (due December) on activities done through your school.

*Provide SOAR with a final report (due April) on activities done through your school.

*Complete virtual training for UCS Schools to receive UCS Funding

If offering Unified Sports - Coaches complete the free online National Federation of High Schools Unified Sports Coaches training coaching a Unified Sport

Supportive School Administrator

Name: School Administrator*

School Administrator's Position*

Email : School Administrator*

Phone #: School Administrator*

Phone

By "signing" below and submitting this form, the school administration and advisor certify that:

The information provided is accurate to the best of my ability;

Your school will comply with all Special Olympics Arkansas policies and procedures, volunteer, Uniﬁed Sports partner & athlete paperwork, and general rules;

Your school will provide Special Olympics Arkansas with requested data throughout the year;

Your school will commit to doing their best in building a school community of inclusion;

Please type your name to complete

Date

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