2014-2015Red Cross/NAIA Collegiate Leadership Program

NATIONAL ASSOCIATION OF INTERCOLLEGIATE ATHLETICS CHAMPIONS OF CHARACTER

Student-Athlete Last Name:

NAIA Institution and Student-Athlete Agreement Form

We the undersigned have read, understand and agree with the benefits and expectations outlined below:
To participate in the program the student-athlete must:

Be a current sophomore in good academic standing at an NAIA Institution.
Agree to serve as a Championsof Character Ambassador.
Attend the Red Cross/NAIA Collegiate Leadership Academy in Washington, D.C., June 2-13, 2014.
Agree to organize at least 2-4 Red Cross blood drives annually on campus.
Start or join a Red Cross club on campus.
Agree to serve on the Red Cross Board of the local Blood Region.
Agree to serve as a NAIA student-athlete representative for Champions of Character.

The student-athlete will receive:

A $2,000 scholarship (disbursed at $500 per semester provided that Program expectations are met) – The Red Cross will distribute the scholarship checks made payable to the institution to be used toward the education of the student-athlete selected. The second semester scholarship will be dependent on first semester performance.
A two-week leadership academy at American Red Cross headquarters in Washington, D.C. (June 2-13, 2014).
Roundtrip transportation to Washington, D.C., room, board and a stipend.
An opportunity to learn from top Red Cross and NAIA representatives.
The privilege to sit on the Board of local Red Cross blood regions throughout the country.
An opportunity to make a significant impact on campus and in the community.

In order for the student-athlete to be eligible to participate in the program the school must agree to:

Support and recognize the student-athlete in forming or joining a Red Cross Club on campus.
Support the ability of the student-athlete to recruit blood donors and collection efforts on campus (ensuring proper facilities are made available for student-athlete to schedule, adequate parking etc.)

(To be completed by Athletics Director)

In nomination of we offer our support of his/her participation in this program, and we agree to allow the Red Cross to

conduct at least two blood drives per year on our campus.

NAIA Institution Blood Drive information:
1. / Blood drives must be sponsored by a campus club or organization.OR Blood drives do not need to be sponsored by a campus club or organization.
2. / Blood is not currently being collected on our campus. OR Blood is currently being collected on our campus by(Please specify blood collection organization)
I certify that the student named on this application is a Yes No
sophomore and in good academic standing.
NAIA Institution President/CEO's Signature / NAIA Institution Athletic Director's Signature / Student-Athlete's Signature

Application

Please note: All applications must be received by the American Red Cross by November 15, 2012. Only complete, typed applications will be accepted. Applications must include a resume, one paragraph bio and an unofficial transcript.

Student-Athlete information:
Student-Athlete Name:
Last / First / Middle
Student-Athlete Student ID # / Student-Athlete Date of Birth / //
Student-Athlete On Campus Address:
Number/Street/Apt No. (or P.O. Box) / City / State / Zip
Email: / Home Telephone No.: / ( )- / Cell No.: / ( )-
Country of Origin / Country of Citizenship
City, State Listed on Driver’s License / Closest Airport
Social Security Number / -- / College Sport(s):
Permanent Address (If different than above):
Address:
Number/Street/Apt No. (or P.O. Box) / City / State / Zip
Telephone No.: / ( )-
Student status:
Are you currently a: / sophomore / Current overall GPA:
Major(s): / Minor(s):
Expected Degree: / Expected Graduation Date:
(ex. Bachelor’s of Arts) / Month / Year
NAIA College/University you are now attending:
NAIA Institution Name:
NAIA Institution Address:
Number/Street (or P.O. Box) / City / State / Zip
Do you have any plans or intentions of transferring before graduation?
Parent/Guardian information:
Parents/Guardians Names: / Mr.Mrs.Ms. Dr. / Mr.Mrs.Ms. Dr.
(Please list ALL) / Title / Last / First / Title / Last / First
Address:
Number/Street/Apt No. (or P.O. Box) / City / State / Zip
Email: / Home Telephone No.: / Cell No.:
Previous involvement with the Red Cross:
Have you ever previously served the American Red Cross as a volunteer or staff? Yes No
If Yes, Where and How?
Student-Athlete Last Name:

Please answer the questions below to the best of your knowledge using only the space provided. Only typed applications will be accepted.

What does the Red Cross mean to you? Please describe any involvement you have had with the Red Cross.

Describe how your training and development as a “Champion of Character” has prepared you for this opportunity/leadership role. (Referring to the NAIA’s program Champions of Character).

Describe one of the NAIA Core Values (integrity, respect, responsibility, sportsmanship and servant leadership) and how it has impacted you as a student-athlete.

List two additional references other than family members (faculty member, coach, or mentor).

1. Name: / Telephone No.: / ( )-
Address:
Number/Street/Apt No. (or P.O. Box) / City / State / Zip Code
2. Name: / Telephone No.: / ( )-
Address:
Number/Street/Apt No. (or P.O. Box) / City / State / Zip Code

Deadline to submit signed and complete applications is November 30, 2013.

Please complete this application in Word. Handwritten applications will not be accepted.

Completed applications should be emailed to:

American Red Cross

Attn: Brian Hamil

6404 Constitution Drive

Fort Wayne, IN 46804

260.433.6867 (p) │260-434-0752 (f)

All applications will be reviewed by the American Red Cross and students will be selected for interviews. The American Red Cross will notify students who are accepted to the Red Cross/NAIA Collegiate Leadership Program by January 15, 2014.

Thank you for applying.

The American Red Cross National Headquartersis an Equal Opportunity/Affirmative Action Employer.

NAIA-Red Cross Collegiate Leadership Program /2014-2015 / page 1