2. Youth Scholarship Application for Utah Youth Prevention Leadership Training at Bryce Canyon

   June 24- 26,2024

   This conference is a great opportunity for youth from the state of Utah to network and learn valuable leadership skills they can take come to their local communities and make a difference.  The Healthy Bluffdale Coalition partners with the Bluffdale Youth Council and will be sponsoring the costs for 4 youth and a chaperone to attend this summer. Following the conference, we will ask each youth to attend the Healthy Bluffdale Coalition meeting and update them on what they learned and want to bring to Bluffdale as a result. Please refer to the conference itinerary and fill out the following application.

   All applications must be submitted by May 24, 2024.

   
   

   Youth Summit Itinerary

   Monday, June 24th

   12:30-1:30 pm: Arrive & Lunch - Be at Ruby Inn at 12:30 pm. Lunch will be cleaned up at 1:30 pm. 

   1:30-2:00 pm: Sign In - Be in seats promptly at 2 pm to begin. 

   2:00-2:30 pm: Welcome, Get to Know You Activity, Pre Test

   2:30-3:30 pm: Speaker: Congress Woman Celeste Maloy

   3:30-4:30 pm: Corbin Allred: Healthy Brain, Healthy Mind

   4:30 -5:30 pm: Get settled in rooms 

   5:30 - 10:00 pm: Tropic Park - Dinner and Network Activity 

   Tuesday, June 25th

   8:00-9:00 am: Breakfast at Ruby Inn Restaurant 

   9:00-9:30 am: Welcome, explain bingo and prizes

   9:30 -10:00 am: Speaker: Logan Reid-Prevention Eras

   10:00-10:15: Explain rotations, divide into groups, head to groups

   10:15-11:15 am: Rotation 1 The Policy Era, Shellsea Ramirez, Fae Dutson, Hailey Jones

   11:15-11:30 am: Rotation Break

   11:30 am - 12:30 pm: Rotation 2 The Planning Era, Melissa Veater 

   12:30-1:30 pm: Lunch and move to next rotations

   1:30-2:30 pm: Rotation 3 My Calming Era, Deanne Smith

   2:30-2:45 pm: Rotation Break

   2:45-3:45 pm: Rotation 4 My Youth Engagement Era, Maddy Bang, Kelci Vandenberghe, Natalia Cervantes

   3:45-4:15 pm: Bingo Drawings, Group Pictures 

   4:15-10:00 pm: Free time with advisor, Dinner on your own as a coalition with youth and advisors, Take opportunity to hike and/or swim, Youth and advisor can gather in the meeting room to play games and socialize if they would like. 

   Wednesday, June 26th

   8:00-9:00 am: Breakfast at Ruby Inn Restaurant 

   9:00-9:30 am: Check out of hotel and drive to Rim - Be at the Rim promptly at 9:30 am to begin

   9:30 -10:00 am: Explain Rim Activity

   10:00 am-12:15 pm: 7 Rotations, 15 minutes each) based on concepts from the healthy brain platter

   12:15-12:30 pm: Return to Ruby Inn

   12:30-1:00 pm: Wrap Up Information - Action Plan, Post test, Lunch

   
   

4. Why do you want to attend this conference?*
6. Three skills of this experience are Public Speaking, Community Service, and Advocacy. Identify one of these three skills that you are good at and why.*
8. Three skills of this experience are Public Speaking, Community Service, and Advocacy. Identify one of these three skills that you would like to learn more about or improve on and describe why.*
10. Describe how youth can make a difference.*
12. Describe an issue in your community you are concerned about.*
16. Youth Full Name*
17. Youth Phone Number*
19. Parent or Guardian Full Name*
20. Parent/Guardian Phone Number*
22. Address*
23. City*
27. Parent/Guardian Agreement*

    By checking the "I agree" box below, you certify that you have discussed this with your parent/guardian and have received permission to go. Additionally, you agree to the commitment of returning from the conference and presenting to the Healthy Bluffdale Coalition what you learned from this experience. Furthermore, by checking this box you certify that you agree to behave and follow instructions as given by the chaperones designated by the Healthy Bluffdale Coalition and adhere to the code of conduct.

     *Applications without a parent/guardian signature will not be considered for youth 17 and younger.

    1. I agree.
29. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
31. Youth Electronic Signature*
33. Parent/Guardian Electronic Signature*
35. Questions?

    Please contact:
    Brighton Wilson , Healthy Bluffdale Coalition Coordinator
    Kjersti Jarman, Youth Council Advisor & Development Coordinator, Bluffdale City

    
    

Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field