ATHLETE LEADER INTEREST FORM

LEAD THE WAY

Interested in shaping the Special Olympics Illinois movement? Fill out the form below to learn more about our Athlete Leadership Programs and how to get started. For additional questions, please contact Michelle Mark at mmark@soill.org.

ATHLETE LEADER INTEREST FORM

"*" indicates required fields

ATHLETE CONTACT INFORMATION

Name

First Name Last Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address*

Phone Number

Region

Agency

Date of Birth (mm/dd/yyyy)

ATHLETE PARENTS/GUARDIAN CONTACT INFORMATION

Parent/Guardian’s First Name

Parent/Guardian First Name Parent/Guardian Last Name

Is your address the same as above?*

Yes

Relationship to Athlete

Email Address

Phone Number

Age of Athlete*

ADDITIONAL INFORMATION

Is the athlete actively involved in Special Olympics and has a valid Medical Application on file?

Yes

Can the athlete travel independently?*

Yes

Has the athlete ever had experience in the following:*

Leading the oath

Yes

Speaking at committee or group meetings

Yes

Being a spokesperson for Special Olympics at conference or for the media

Yes

What is the reading level of the athlete? (Approximate level or description if unsure):

Please check the areas that you are interested in:

Becoming an Athlete Leader

Advanced/Role-Specific Leadership Courses

Governance Workshop

ADDITIONAL INFORMATION

Speech Coach’s Name*

Speech Coach’s First Name* Speech Coach’s Last Name*

Is your address the same as above?

Yes

Email Address

Phone Number

Relationship to Athlete