DETROIT DEBATE INSTITUTE APPLICATION
DEADLINE: Thursday, July 11th, 2013
UPDATED DEADLINE: JULY 31ST 2013
Please complete this application and email to 2013detroitdebateinstitute@gmail.com when
completed or mail to:
Holly Reiss
Detroit Urban Debate League
3011 W. Grand Blvd., Suite 1200
Detroit, MI 48202
Please enclose a check or money order for $500 made payable to the “Detroit Urban Debate League” with
your application. If you attend a Detroit UDL member school, you are eligible for a full scholarship to
the Detroit Debate Institute. This means that Detroit UDL members attend at NO COST.
HIGH SCHOOL: _________________________________________________ Today’s DATE: _______________________
Your NAME: _________________________________________________________________________________________
Your Birthdate:
________________
Month
_______
Day
___________
Year
Your
ADDRESS:______________________________________CITY______________________STATE_____ZIP_________
PHONE (cell)___(______)______________________________(alternate)__(______)____________________________
EMAIL (best) ________________________________________________________________________________________
Emergency contact Name:_____________________________________Phone_____________________________________
Emergency Contact Relationship to you: (circle one)
Parent
Guardian Spouse
Other:__________________
I am a…. (please circle one):
MIDDLE SCHOOL STUDENT
/
HIGH SCHOOL STUDENT
/ DEBATE COACH /
VOLUNTEER
If you are a student, please indicate:
If you are a student, coach or volunteer, please indicate:
YEAR IN SCHOOL: _________________
(6, 7, 8, 9, 10, 11, OR 12)
YEARS IN DEBATE: ___________________
(including this year)
(0, 1, 2, 3, 4, etc…)
Please indicate: ETHNICITY:
African-American
Asian
Caucasian
Native American
If you are a student, DO YOU QUALIFY FOR FREE OR REDUCED LUNCH?
Hispanic
Multi Racial
Yes____________ No_____________
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SCHOLARSHIP APPLICATION FORM
Your Name:_____________________________________________________________
Please explain below why you would like to be considered for a scholarship to the Detroit Debate
Institute:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What do you hope to gain from attending the DDI?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Would you be willing to volunteer at one or two debate tournaments during the 2013-2014 school
year? (circle one) Yes / No
If yes, please rank your preferred ways of volunteering from 1 to 5
(1 = most preferred, 5 = least preferred).
Judging debate rounds
_____________
Helping with lunch/breakfast
_____________
Registration/information table
_____________
Tabulation room
_____________
Tournament announcements/ news stories / press releases
_____________
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PHOTO CONSENT AND RELEASE FORM (ADULT)
If you are 18 or older, please sign the following release:
To Whom It May Concern:
I, ___________________________________________________________________________________
(please print full name above), hereby consent to be photographed, videotaped, audio taped and/or interviewed
for public relations or educational purposes during Detroit Urban Debate League events/activities. I also consent
to the Detroit UDL’s use of my photograph or likeness or voice on their website, on educational CD, promotional
materials or other electronic/digital media. I agree to release and hold harmless the Detroit Urban Debate League,
its members, trustees, agents, officers, contractors, volunteers and employees from and against any and all claims,
demands, actions, complaints, suits or other forms of liability that shall arise out of or by reason of, or be caused by
the use of my photograph, likeness or voice on television, radio or motion pictures, or in the print medium, or on
the Internet or any other electronic/digital medium.
It is further understood and I do agree that no monies or other consideration in any form, including
reimbursement, for any expenses incurred by me, will become due to me, my child, our heirs, agents, or assigns at
any time because of my participation in any of the above activities or the above-described use of my child's
photograph, likeness or voice.
Your Name
____________________________________________________
Address
____________________________________________________
____________________________________________________
_________________________________________ ____________________
(Signature)
Date
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PHOTO CONSENT AND RELEASE FORM (MINOR)
If you are younger than 18, please return the following release with the
signature of your parent or guardian.
School ___________________________________________________ Date__________________________
To Whom It May Concern:
I hereby consent to have my (daughter / son / niece / nephew / ____________),
____________________________________ ( print student’s name)
photographed, videotaped, audio taped and/or interviewed for public relations or educational purposes during
Detroit Urban Debate League events/activities. I also consent to the Detroit UDL’s use of my child 's photograph
or likeness or voice on their website or on an educational CD, promotional materials or other electronic/digital
media. As the child's parent or legal guardian, I agree to release and hold harmless the Detroit Urban Debate
League, its members, trustees, agents, officers, contractors, volunteers and employees from and against any and all
claims, demands, actions, complaints, suits or other forms of liability that shall arise out of or by reason of, or be
caused by the use of my child's photograph, likeness or voice on television, radio or motion pictures, or in the
print medium, or on the Internet or any other electronic/digital medium.
It is further understood and I do agree that no monies or other consideration in any form, including
reimbursement, for any expenses incurred by me or my child, will become due to me, my child, our heirs, agents,
or assigns at any time because of my child's participation in any of the above activities or the above -described
use of my child's photograph, likeness or voice.
Student Name
____________________________________________________
Address
____________________________________________________
____________________________________________________
Guardian’s Name
____________________________________________________
____________________________________________________
(Signature of Parent or Guardian)
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ACADEMIC RESEARCH CONSENT FORM (STUDENTS)
Your student is invited to participate in a research study about the affect of debate participation on reading, academic
achievement, graduation rates, attendance, and behavior. Your student has been asked to participate because they have joined
their schools' debate team and have participated in Detroit Urban Debate League events and tournaments.
The purpose of the research is to determine how much debate influences students' overall academic achievement, behavior, and
graduation rates. This study will include data from high school debaters and non-debaters.
WHAT WILL MY STUDENT’S PARTICIPATION INVOLVE?
With your permission, the academic scores, GPA, attendance, and disciplinary records for your student will be collected from
his/her academic institution. His/her identity will remain completely confidential, matching data to student numbers to protect
the student's identity.
ARE THERE ANY RISKS OR BENEFITS TO MY CHILD?
We don't anticipate any risks or benefits to your child from participation in this study.
HOW WILL MY CHILD’S CONFIDENTIALITY BE PROTECTED?
While there will probably be publications as a result of this study, your child’s name will not be used. Only group characteristics
will be published.
WHOM SHOULD I CONTACT IF I HAVE QUESTIONS?
You may ask any questions about the research at any time. If you have questions about the research after you leave today you
should contact Holly Reiss, Detroit Urban Debate Research Consortium at 313-585-0028.
Your child’s participation is completely voluntary. If you decide not to participate it will have no effect on any services your child
is currently receiving.
Your signature indicates that you have read this consent form, had an opportunity to ask any questions about your participation in
this research and voluntarily consent to participate.
Student Name
____________________________________________________
Address
____________________________________________________
____________________________________________________
Yes, I consent to allow my child’s academic and behavioral data to be used in academic research with the understanding
that his/her identity be kept confidential.
____________________________________________________
(Signature of Parent or Guardian)
No, I do not consent to allow my child’s academic and behavioral data to be collected for use in academic research.
____________________________________________________
(Signature of Parent or Guardian)
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