EmailMe Form - Statewide Youth Leadership Award

The 84 Movement wants to honor a youth leader from Massachusetts.

The 84 Movement’s Statewide Youth Leadership Award is a chance for you to EXPRESS YOURSELF and BE RECOGNIZED for the great work you do in your community and in the state for tobacco prevention!

AWARDEE WILL RECEIVE:
• Recognition at Kick Butts Day: Take Down Tobacco at the Massachusetts State House on Wednesday, April 29, 2020
• Recognition on The84.org and other social media (photo and profile will be posted)
• A scholarship of $500
• Potential press coverage and recognition by legislators in your district

BASIC ELIGIBILITY – Any young person who:
• Is a Massachusetts resident
• Is of high school age (between 13-19 years of age in grades 9-12)
• Has been doing work in tobacco prevention since at least April 2018 (if not longer!)

HOW DO I APPLY?
• Fill out the application form and answer ALL the questions
• Get an adult who knows your tobacco prevention work to fill out the short Adult Advisor Recommendation form
• Submit this form by 5PM Tuesday, March 24, 2020

AND THEN WHAT?
• You will be notified by Wednesday, April 9, 2020 if you have been selected.
• Join The 84 for Kick Butts Day: Take Down Tobacco at the State House to continue bringing awareness to the issues surrounding the tobacco and vaping industries and celebrate your hard work in The 84 Movement this year!

For questions and more information, contact Ed Rand at erand@hria.org 617.279.2260

Fill out the application form and answer ALL the questions

Note: You will need an adult who knows your tobacco prevention work to fill out the short recommendation form at the bottom of this application.

Name of applicant: *

Grade *

Are you 19 or younger? *

Y

N

Date of Birth *

MM / DD / YYYY

When did you begin working in tobacco prevention? *

Will you attend Kick Butts Day: Take Down Tobacco 2020 at the Massachusetts State House where the winners will be honored? *

Y

N

Address (Street) *

City *

Zip *

Email *

Phone *

School/Organization *

84 Chapter *

Name of recommender *

Position *

Describe your experiences with tobacco prevention.

Please keep each answer to a 250 word maximum.

Your responses will be evaluated by the selection committee(s) on the following:
• Were your responses clearly written?
• Did you demonstrate leadership in your community and/or statewide?
• Did you give concrete examples where applicable?
• Did you show an understanding of advocacy/community organizing?

1. What are you doing as an individual to address tobacco issues and how is it contributing to making your school, neighborhood, and/or community healthier and more tobacco free? *

2. How have you made a statewide impact in the fight against the tobacco and vaping industries or how has your work in The 84 Movement been outstanding? *

3. What is your personal connection to fighting tobacco? Please be specific. *

4. What does leadership mean to you? Provide an example of a time you showed leadership through The 84. *

5. Are there other comments you would like to share with us about your leadership skills and experience? *