2015Local Program

AccreditationApplication

And

Susan Saint James Endowment Request for Funding

ACCREDITED

Covered by Special Olympics Insurance Policy

May attend Special Olympics Connecticut Competitions and other Sanctioned Events.

May submit coach and/or athlete nominations for events outside CT

May attend Special Olympics competitions outside of Connecticut

Permission to use Official SOCT logo

May share in collaborative fundraising ventures with SOCT or SOI

May apply for any available SOCT and/or SOI grants

NOT ACCREDITED

Those Local Programs not adhering to theSpecial Olympics General Rules, The Official Special Olympics Sports Rules, and all other operating polices and procedures established by Special Olympics, Inc. and Special Olympics Connecticut. Local Programs that fail to be accredited forfeit the right to use the Special Olympics name, logo, and other proprietary marks.

SOCT Headquarters has the power to suspend or permanently ban any Special Olympics Local Program from participation in Special Olympics, impose sanctions on a program, or suspend or revoke an accredited program’s accreditation.

APPLICATION FOR LOCAL PROGRAM ACCREDITATION

Local Program Name:Applying for Accreditation

.

THIS APPLICATION WAS PREPARED BY:

______

First NameLast Name

______

Title/Position on Local Program Committee

______

Address City/State/Zip

______

Telephone (Daytime)Telephone (Evening)

______

E-mailFax

ACCREDITATION STANDARDS ACKNOWLEDGMENT

As Local Coordinator of Special Olympics Connecticut, Inc., I acknowledge that I have reviewed this Application for Accreditation and all statements made herein are true. I further acknowledge that I have reviewed and understand the rules, policies and procedures established by Special Olympics, Inc., Special Olympics Connecticut, Inc., the Official Special Olympics General Rules, and the Official Special Olympics Sports Rules. I understand that Accredited Programs are committed to abide by all rules, policies and procedures established by Special Olympics, Inc., Special Olympics Connecticut, Inc., the Official Special Olympics General Rules and the Official Special Olympics Sports Rules and that non-compliance may result in loss of accreditation at any time and loss of the right to use the Special Olympics name for any purpose whatsoever. I acknowledge that I serve in a voluntary capacity as Local Coordinator for Special Olympics, Inc., and Special Olympics Connecticut, Inc., and may be removed at any time for any reason.

Local Coordinator’s Signature: ______Date:

Co-Local Coordinator’s Signature: Date:

If Local Coordinator information is different than above

______

First NameLast Name

______

Address City/State/Zip

______

Telephone (Daytime)Telephone (Evening)

______

E-mailFax

PLEASE SUBMIT THIS APPLICATION TO SOCT BY JANUARY19, 2015

** For Local Programs who have a Unified Sports® Fitness Club, you do not have to complete a separate USFC Accreditation Application. This Accreditation Application will suffice for both.

2015 LOCAL PROGRAM BUDGET / Revenue & Expense Form

Please list all revenue and expenses for the 2015 year. List events and games registrations pertinent to your Local Program. Program cannot operate at a loss. Programs are encouraged to start a reserve of at least 10% of their yearly operating budget. If no budget is submitted, you will not be eligible for accreditation.

PROJECTED REVENUE / $ AMOUNT / PROJECTED EXPENSE / $ AMOUNT
Registration Fees: / Registration Fees:
Winter Games / Winter Games
Summer Games / Summer Games
Fall Sports Festival / Fall Sports Festival
Holiday Sports Classic / Holiday Sports Classic
Invitational/Time Trials
Fund Raisers: please list / Fund Raising: please list
Donations-Individuals / Conferences/Summits
Corporate/Civic Groups
Souvenir Sales / Souvenir Sales
Special Events: i.e. / Special Events: i.e.
Dance / Dance/Team Picnic/Dinner
Dinner
Penguin Plunge
Postage
Telephone/Technology
Administrative
Grants / Printing
Facility Rentals
Other Sources of Revenue / Equipment
Uniforms
Transportation
Meals
TOTAL / TOTAL

Local Programs may use this form or submit their own detailed budget form

GOALS

Please list 2-3 goals that ______Local Program will achieve for 2015. Include completion dates. Please identify your goals in areas of fund raising, new sports or volunteer/coaches training.

  1. ______

______

Completion date: ______

  1. ______

______

Completion date: ______

  1. ______

______

Completion date: ______

Answers to the following questions will assist in our 2015 Program Planning and help direct needed resources to your local program.

  1. Do you plan on adding any new teams or sports in 2015?

____Yes____No

If yes, what team or sport? ______What age group? ______

  1. Are you able to accommodate more athletes in your program in 2015?

If yes, what sports ______What age group? ______

If no, what sports ______

  1. In what sports can your program use:

Coaches: ______

Unified Partners: ______Age Groups______

Athletes: ______Age Groups______

Training Facilities: ______

  1. Would your Program be interested in starting Offer a Unified Sports ® Fitness Club? Yes/No ______
  1. Is your program interested in hosting a multi-local scrimmage/competition?

Yes/No______If yes, what sport(s)? ______

Susan Saint James Endowment Request

This endowment was established by Susan Saint James for Local Programs. Annual funding is based on the average fair market value of the endowment over the past three years and the amount of local programs who submit this grant by the deadline.

Before you submit this grant please make sure you have done the following to be eligible for funding:

  • Complete and submit your Local Accreditation Form to the SOCT c/o Marc Mercadante by the January 19, 2015 deadline, postmarked appropriately.
  • Complete your Local Coordinator Survey by January 19, 2015 (will be e-mailed to you, one survey required per Local Program)
  • Local Programs in the New London area who are eligible for funding through the Eunice Murtha Endowment are not eligible for this funding

Please indicate how you will use the funding by checking off the categories from the approved listing of expenses:

Sports Equipment

Transportation for Games/Training

Stipends for Administrative Support

Games Assessment Fees

Sports Facility Usage

Awards Banquet for Athletes/Volunteers

Uniforms

Please describe how this funding will help your local program:

Local Coordinator SignatureDate

Local Program Name

Any questions regarding this can go to Rich Kalcznski, Local Coordinator Representative at or (203) 509-5243.