Step Up! Bystander Intervention Facilitator Training

NCAA Application for Sponsorship of

Step Up! Bystander Intervention Facilitator Training

Kansas City, Missouri May 15-16, 2014.

The NCAA will sponsor registration and lodging for select teams from NCAA member institutions -- consisting of one representative from Athletics and one from Student Affairs -- to attend the Step UP! Bystander Intervention Facilitator Training and Conference. Sponsored teams will be responsible for travel.

The training will provide resources for athletics and student affairs professionals to work in partnership to promote student-athlete wellness through bystander intevention training. Please provide complete information on the reverse side*

Sponsored individuals agree to be a resource for their institution and assist others in conducting Step Up! Bystander Intervention Training to benefit all students, including student-athletes.

To apply please complete this form, sign, scan and email to Mary Wilfert by March 10, 2014. Questions? Email or call 317-917-6319.

Applicants will be notified April 1 whether they have been selected.

Conference registration will open up for all on April 1.

Registration fees for non-sponsored applicants is $100.

Team members:

Athletics Representative Student Affairs Representative

Name
School
Position
Email
Phone

Signatures: I agree that by accepting NCAA Sponsorship to attend the Step Up! Bystander Intervention Facilitator Training and Conference, I will serve as a resource to others at my institution and other local institutions.

Athletics Representative Student Affairs Representative

SIGN:

*Please provide the following information:

Athletics Professional:

1. Name/Title:______

2. Degree:______

3. Name two current wellness programs on which you are working:______

4. Provide a brief statement why you plan to bring Step Up! to your campus: ______

5. Have you collaborated with other campus professionals previously? Y/N_____ If so, please share one example:______.