SAVE Awards Program Application

Please complete a form for EACH group or presentation type

Please read the SAVE Awards Guidelines (PDF) prior to submitting this application

I have read the SAVE Awards Guidelines *

Yes

Presentation Type *

Organization/School *

Director/Principal *

Address *

City *

Zip *

Website

____________________________________________________________

Group Advisor #1 *

Title *

Mailing Address *

City *

Zip *

Phone *

Fax

Email *

____________________________________________________________

Group Advisor#2 *

Title *

Mailing Address *

City *

Zip *

Phone *

Fax

Email *

____________________________________________________________

Name of Group *

# of members *

Age Range *

Briefly describe the function or purpose of your group *

When will your group regularly meet to prepare their violence prevention message? (Day/Time) *

Who will be responsible for transportation of youth to and from program activities? *

What clear, concise violence prevention message will be conveyed by your group? *

I acknowledged that I have read the SAVE Awards guidelines. As Group Advisor, I will be directly responsible for the coordinating of group activities. I understand and will comply with all guidelines, including but not limited to all meetings, evaluation deadlines, training schedules and rehearsals. My compliance with the program dates and guidelines are necessary for my youth's participation in the SAVE Awards Program. I understand that not adhering to these guidelines will terminate my group's participation in this program.

Name of the person completing this form *

Type word or code as shown for application verification

__________________________________________________________

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