Spring 2015
Dear Prospective Youth Ambassador,
I hope that you will consider joining the Youth Ambassador Program at the Long Island Chapter of JDRF.
Youth Ambassadors are children with type 1 diabetes (T1D), age 18 and under, who are involved with
the educational and volunteer efforts of JDRF’s Long Island Chapter. Youth Ambassadors contribute to
increased awareness in our community. With your voice and leadership you will help us inspire and
motivate our sponsors, corporate partners, event participants and donors, so they can see firsthand the
importance of finding a cure for T1D! By becoming a Youth Ambassador, you will represent JDRF, Long
Island, as the face of T1D in our region! The JDRF Youth Ambassador Program also provides social
opportunities to promote friendship, support of each other and good times!
You have the ability to spread diabetes awareness to the community and support JDRF in many ways
that only YOU can! Enclosed you will find an application that includes the responsibilities that you will
be asked to fulfill, as well as the application required for the program. Should you have any questions
and/or concerns, please do not hesitate to contact me.
Please complete the application and submit it to the JDRF Long Island office. You can mail it to JDRF,
Long Island - 532 Broadhollow Road, Suite 118, Melville, NY, 11747 or e-mail it to me at
bpaffmann@jdrf.org. We also ask that you please provide a photo to be used for marketing and
communication opportunities.
On behalf of JDRF, I look forward to working with you! Together we can make a difference!
Warmest regards,
Betsy Paffmann
Outreach Manager
JDRF – Long Island
Youth Ambassador 2014 Application
Name
Birthday
Date Diagnosed
Child’s Name: __________________________________________________________________
Parents Name: _________________________________________________________________
Mailing Address: ________________________________________________________________
City: ___________________________
Phone (H):___________________________
State: __________
Zip: ____________________
(C):______________________________
Parents e-mail:__________________________________________________________________
Do you have an E-mail you would like to share? _______________________________________
Date of Birth: ______________________ Date of Diagnosis: __________________________
School: ________________________________________
Grade: __________________
Do you currently have a Walk to Cure Diabetes Walk Team? ___YES
___NO
If yes, what is your walk team name? __________________________________
Is your school currently involved with the Kids Walk Program? ___YES
___NO
If yes, please describe the program
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Parents Signature ______________________________________________________________
By signing this form you are giving your child permission to participate in the Youth Ambassador Program.
Did you remember to include a current photo? Please sign to authorize use of the photograph
for promotion of JDRF events and purposes.
I, _______________________, as the parent/guardian of _____________________________,
do hereby consent and authorize JDRF to use and reproduce photographs for use in the promotion of JDRF events
and purposes.
Please return your completed application & waiver to Betsy Paffmann, Outreach Manager to
Email: bpaffmann@jdrf.org/ Mail: 532 Broadhollow Road, Suite 118, Melville, NY 11747
What to look forward to as a JDRF Youth Ambassador
Youth Ambassadors are required to support our JDRF, OneWalk and/or Kids Walk Program, as well as
provide additional volunteer hours to JDRF at signature events and stewardship activities.
Please check off the areas that you would like to participate to fulfill your Youth Ambassador
requirements. Please be advised that most middle and high schools require community service hours
and many of these activities will qualify.
Outreach Events
__ New Family Events
__ TypeOneNation Summit
__ Community Efforts - provide diabetes education through various initiatives - schools, hospitals,
organizations, etc.
__ Youth Ambassador Art Project
__ Halloween Party
__ Bring Diabetes to Light Program
__ Mentor Program
Signature Events
(Limited number of Youth Ambassadors are needed at signature events and therefore will be selected based
on yearly participation and, if necessary, via a drawing and rotation process).
__ Gala
__ Tee Up to a Cure
__ Annual Research Meeting
__ Walk Kick-off Events
__ Chapter Walk Awards Ceremony
Fundraising Events - Speakers Bureau
__ Work with fundraising staff to motivate people to give donations and become involved with our
organization through presentations and speaking engagements such as corporate kickoffs.
__ Sneaker Campaign
__ Ride Information Nights
Government Relations
__ Promise to Remember Me Meetings
__ Advocate Recruitment at programs/events
__ Advocacy Team (ages 12 – 18)
Miscellaneous
__ Make calls/write notes to JDRF donors and sponsors to thank them for their support
__ Provide office assistance
__ Ford Race Car Design Contest Program