Youth Ambassador Program Application

The Youth Ambassador is a young individual – 14-17 years of age – living with Sickle Cell Disease (SCD) who will play a key role in supporting initiatives that empower and uplift fellow SCD warriors. This ambassador will contribute to collaborative discussions, resilience-building resources, and virtual transition tools to help improve the quality of life for youth with SCD. This role has a 10 month timeframe expected to align with the school year.

* Required

20%

Before beginning the application, please read the Youth Ambassador Role and Responsibilities.

Full Name *

Age (must be 14-17) *

Date of Birth *

Address *

City *

State *

Zip code *

Phone number *

Email *

Do you have a diagnosis of Sickle Cell Disease (SCD)? *

Yes

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Parent or Guardian Contact Information

Parent information is mandatory

Parent/Guardian Full Name *

Relationship *

Mother

Father

Legal Guardian

Contact phone number *

Email address *

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Qualification questions

Short answers

Why are you interested in becoming a Youth Ambassador for the Sickle Cell Foundation? *

What unique perspective or experience can you bring to this role as a warrior living with SCD? *

Given the opportunity, how would you use your voice in conversations to collaborate with medical professionals, or community leaders who may be unfamiliar with SCD? <Collaborative Conversations> *

How do you think you can use your experiences and voice to help create an online educational program for community awareness? <Resilence Toolkit> *

How would you use your voice to help youth prepare to transition their care and needs to adulthood? <Transition Module> *

What are some skills or talents you have that could help you be an effective ambassador (e.g., public speaking, social media, writing, leadership, etc.)? *

What does resilience mean to you as someone living with Sickle Cell Disease? *

Availability

Your ability to commit

Are you able to commit to monthly meetings, virtual training sessions, and special events as needed? *

Yes

Other

If you answered 'other' above, please explain:

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References

Please provide two people of reference

Name, Relationship to you, Contact phone and email *

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