AZYLF Delegate Application 2022

Arizona Youth Leadership Forum (AZYLF) is facilitated by Diverse Ability Incorporated
AZYLF 2022: GRIC Participant Application

Arizona Youth Leadership Forum for Teens and Young Adults Who Have Disabilities for Gila River Indian Community is an innovative multi-day conference being held weekends in October at the Chandler–Gilbert Community College. For nine years, AZYLF has continued to successfully serve youth who have a variety of disabilities and diversities. We are committed to Native Youth leadership and engagement, and wish to cultivate a rich relationship with the community. Previous AZYLF Graduates have represented the Hopi, Laguna, Lakota, Navajo, Pasqua Yaqui, Pima, Sac and Fox, Seneca, and White Mountain Apache tribes.

Youth are selected to attend AZYLF based upon their leadership potential and skills. During the conference, youth participate in a dynamic experience that focuses on self-discovery, leadership development, career exploration, effective advocacy, and empowerment through heightened awareness of disability history and culture. Through Person-Centered Planning, youth are assisted in developing a Personal Leadership Plan which includes specific action items they choose to address as they navigate their futures.

AZYLF is a safe space for everyone to share their experiences, ideas, and feelings. Presentations by a variety of community leaders advocates, elders and peers who have disabilities, are in integral component of AZYLF. Each presentation highlights an area of impact for youth as they prepare for and navigate young adulthood. AZYLF is packed with a variety of experiential activities including engagement in service to others. We also hold a memorable Graduation Celebration where traditional clothing or Regalia are welcome for this festive occasion.

AZYLF 2022: GRIC will take place on the following weekends in October: 10/1, 10/2, 10/8, 10/9, and 10/15 beginning at 9 am. Participants may attend online via Zoom or in-person. The in-person conference will be held at Chandler–Gilbert Community College located at 2626 E Pecos Rd, Chandler, AZ 85225. Three meals with be provided each day for all in-person participants. There will be strict COVID Protocols in place for the in-person conference. Please review them at the following link, and do not plan to participate in-person if you do not meet the vaccination requirement, or if you will not adhere to these protocols:

https://diverseabilityincorporated.org/arizona-youth-leadership-forum-azylf/#1650044139987-36fe5378-1c90

Please carefully read and complete this application before 11:59 pm on Tuesday, September 27, 2022.
Please select the AZYLF Conference for your Regional Location. If by chance, you cannot attend in the Region in which you reside, please check the Regional Location you would like to be considered for, as well as the final box, which indicates your intent to be considered for attendance outside of your Region of residence. *
Do you wish to attend AZYLF 2022: GRIC in person or online?*

In Person (NOTE: you must complete the COVID Procedures form, including uploading your full vaccination status to participate in person)Online

AZYLF 2022: GRIC Selection Process

To be eligible, youth must meet the following requirements:
- Member of Gila River Indian Community
- Identify as having a disability
- Be in high school, or be a young adult under the age of 30
- Wish to increase personal leadership, self-reliance, and self-advocacy skills
- Aim to interact respectfully with peers and elder role models
Applicants must electronically submit the completed application packet by 11:59 pm on Tuesday, September 27, 2022.
- We will be responding to applicants to arrange for interviews as applications are received. Interviews will take place October 1-2, 2022. Successful applicants will be notified of their selection as soon as possible following the application closing date, and interview completion.
- After being selected, and prior to participation, youth will be required to complete a comprehensive confirmation form, which includes health and safety information, and may include a Pre-Employment Transition Services Verification Form, and/or other required documentation for AZYLF or funding sources.
- There is no charge for youth to participate in AZYLF.
- Accommodations such as: ASL interpreters, captioning, and in person assistance services, are provided at no cost.
***PLEASE NOTE: AZYLF Graduates are ineligible to apply. We encourage Graduates to actively engage with the AZYLI Alumni Association. Learn more at: diverseabilityincorporated.org.***

Personal Contact Information
Applicant First Name*
Applicant Last Name*
Preferred Name/Nickname Used
Residence Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Residence*
Please select one.
Mailing Address, if different from Residence

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Email*
example@example.com
Applicant Phone Number*

Area CodePhone Number
Parent/Guardian Email (if applicable)
example@example.com
Parent/Guardian Phone Number (if applicable)
Applicant Date of Birth

MonthDayYear
Date
Applicant Age*

14-2223-29
Applicant Ethnicity (Optional and appreciated)
Applicant Gender Identity*
What is your disability/are your disabilities?*
What is your disability/what are your disabilities called? If unknown, please ask your parent, teacher, or doctor. Please be as specific as possible.
What areas of your life do you notice that your disability challenges you?*
For example: learning, getting around, seeing, hearing, reading, driving, socially, doing things for and by myself, etc.)

Education and Community Involvement
Applicant Current Grade or Educational Level*
Expected Date of Graduation/Year Graduated*
Are you in School?*

YesNo
If Yes: Name and City of School Attending
Will you be aged 22 or younger on August 1, 2022, and will you be a student in a high school, community college, college, or university setting in the summer or fall of 2022?*

YesNo
Below, please list your involvement with your school and/or community. This may include community activities, group or club memberships, leadership positions you have held, service to others you have completed, after school activities, and/or work experiences you have had.*
Work: What kind? School: For what? Volunteer: Where?
What are your future educational plans or goals? If you are not a student, and do not plan to return to school, please share any learning opportunities you may be considering. *
Work: What kind? School: For what? Volunteer: Where?
What are your current work or career plans or goals? *
Work: What kind? School: For what? Volunteer: Where?

AZYLF 2022: GRIC Readiness Questions

Your answers to the following questions will be used to assess your readiness to participate in AZYLF. Please answer the following four questions in the spaces provided below:
Question 1: OPPORTUNITY - Please describe what it would mean to you to be selected to participate in AZYLF, and how you feel you would positively contribute to AZYLF?*
Question 2: POSITIVE INFLUENCES - In terms of leadership, please tell us about two people who have positively influenced your life, and how they did so?*
Family Members, teachers, counselors, friends, public officials, cultural heroes, or celebrities are acceptable examples.
Question 3: PERSONAL DISABILITY EXPERIENCE - Please describe how you feel about having your disability, how you communicate about your disability to others, and what you have learned about yourself, because you have your disability.*
Question 4: FUTURE PLANS - Please describe any plans you have for your future, such as: what you wish to explore, accomplish, change, or do, in relation to your home life and involvement in the community. *

Letters of Recommendation

You must ask two people to provide a recommendation for you which describes your skills, abilities, and experience in personal leadership, self-advocacy, ability to work collaboratively with others, and overall qualities and attributes.

It is preferred that the recommendations come from people who are not related to you, if possible.

Please direct your recommenders to the website at diverseabilityincorporated.org, where they will be able to complete a recommendation on your behalf. Or, send them this link:

https://diverseabilityincorporated.org/azylf-recommendation-form/

Please provide the name and contact information of each Recommender, below:
First Recommender Name and Relationship to you:*
For example: Jane Smith, Physical Therapist or John Jones, Teacher
First Recommender Phone Number*

Area CodePhone Number
First Recommender Email*
example@example.com
Second Recommender Name and Relationship to you:*
For example: Mary Brown, Club Advisor or James Davis, Pastor
Second Recommender Phone Number*

Area CodePhone Number
Second Recommender Email*
example@example.com
AZYLF 2022: GRIC, Online Accommodations

Individualized accommodations will be celebrated and honored, and a variety of avenues for self-expression and interaction will be embedded throughout AZYLF.
Please check the boxes below that are true for you. Your responses are to assist us with planning for a hybrid AZYLF experience, and do not factor into our selection decisions, in any way:*

I have both reliable internet service, and technology that would allow me to connect to a videoconference platformI have reliable internet service, but do not have technology that would allow me to connect to a videoconference platformI have technology that would allow me to connect to a videoconference platform, but do not have reliable internet serviceI have neither reliable internet service, nor technology that would allow me to connect to a videoconference platformI will need an ASL Interpreter in order to participate in AZYLFI will need captioning in order to participate in AZYLFI will need in person assistance in order to participate in AZYLF (this could include assistance with physical access, maintaining focus, computer skills, etc.)I use a screenreader, or other form of assistive technology that will need to be checked for compatibility prior to participating in AZYLF
AZYLF 2022: GRIC, Online Rules and Requirements

Youth are selected to attend Arizona Youth Leadership Forum (AZYLF) based upon their leadership potential and skills. Participants are expected to conduct themselves accordingly, and must:
- Communicate with AZYLF Conference planning team members regarding accommodation and/or technology needs to ensure a successful participation experience, in accordance with established deadlines.
- Return all required information by established deadlines, and prior to participation.
- Maintain a respectful attitude toward all peers, presenters, and AZYLF team members.
- Be available between 9 am-9 pm on scheduled conference dates (there will be multiple sessions per day, each day).
- Participate in all conference sessions.
- Be punctual and follow the conference schedule.
- Parents/Guardians/Other Supporters, will be asked to allow the youth time and space, free from interruption, throughout the AZYLF conference, to maximize their opportunity to learn and grow, challenge themselves, and engage to the fullest.
Youth who do not follow these rules and requirements may be unable to continue participating. Your application to Arizona Youth Leadership Forum confirms your acceptance of these rules and requirements.

Remember the responsibility that goes with the honor of being selected to AZYLF...and plan to have a great time!

AZYLF 2022: GRIC, In-Person Accommodations
Please check the boxes below that are true for you. Your responses are to assist us with planning for a hybrid AZYLF experience, and do not factor into our selection decisions, in any way:

I will need an ASL Interpreter in order to participate in AZYLFI will need captioning in order to participate in AZYLFI will need support with reading, writing, or typing in order to participate in AZYLFI use a screenreader, or other form of assistive technology that will need to be checked for compatibility prior to participating in AZYLFI have a tablet or laptop I can bring to use at AZYLFI need a tablet or laptop supplied to me for AZYLFI need additional accommodations not listedOther
AZYLF 2022: GRIC, In-Person
Rules and Requirements

Youth are selected to attend Arizona Youth Leadership Forum (AZYLF) based upon their leadership potential and skills. Participants are expected to conduct themselves accordingly, and must:
- Adhere to all the COVID-19 protocols in place for the duration of the conference.
- Communicate with AZYLF Conference planning team members regarding accommodation and/or technology needs to ensure a successful participation experience, in accordance with established deadlines.
  Return all required information by established deadlines, and prior to participation.
- Be punctual and follow the scheduled program. Attendance at all sessions is required.
- Maintain a respectful attitude toward peers, presenters, and AZYLF Facilitators
- Respect the facilities and all who are in them.
- Possession or use of alcohol, tobacco, or illegal substances is strictly prohibited. (Prescription or approved medications require documentation. Medication reminders and requested accommodations will be provided.)
- Headsets, radios, electronic devices, and cellular phones are allowed on site, but use is NOT permitted during scheduled AZYLF activities. Use of such items will only be permitted during designated breaks, unless they have been identified as an accommodation.
- An emergency telephone number will be provided to Parents/Guardians/identified Supporters, as youth will be engaged throughout the day, and will not be available to check their phones during scheduled activities.
Any violations of these rules may result in the youth being unable to continue participating, which may result in youth being sent home immediately at the their own expense or the expense of their parent/guardian. Submission of your AZYLF application confirms your acceptance of, and agreement to follow, these rules.

Remember the responsibility that goes with the honor of being selected to AZYLF...and plan to have a great time!

Did anyone assist you in completing this application?*

YesNo
If yes, please specify who:
Did someone refer/encourage you to submit this application?*

YesNo
If yes, please specify who:
By signing my name below, I attest that I understand the information herein, and that this application is accurate to the best of my knowledge:*
Type Name Here, Sign Below
Applicant Signature

Clear
Parent/Guardian Signature (if applicable): By signing my name below, I attest that I understand the information herein, and that this application is accurate to the best of my knowledge:
Type Name Here, Sign Below
Parent/Guardian Signature (If Applicable)

Clear
If you are applying to participate in AZYLF 2022: GRIC in person, a link to the COVID-19 Procedures Form will be emailed to you. No one will be permitted to participate in person without this form completed.
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Arizona Youth Leadership Forum (AZYLF) is facilitated by Diverse Ability Incorporated