Delaware County Prevention Council
3595 N. Briarwood Lane Muncie, IN 47304 Phone: 765.282.7988 Fax: 765.289.8020
April 19, 2013
Dear Student,
Thank you for your interest in learning about the awesome Delaware County PRIDE Team! We are a performancebased team comprised of high school leaders who spread our commitment to an alcohol, tobacco, and drug-free
lifestyle through interactive presentations which use a variety of talents including, dance, skits, instruments, tumbling,
vocals, public speaking, drawing, etc., etc., to help enhance our drug-free messages at school and community events.
Our team is under the direction of the Delaware County Prevention Council, a 501c3 non-profit organization, whose
mission is to plan, strengthen, and coordinate community efforts in the areas of alcohol and drug prevention,
treatment, and law enforcement.
We are currently seeking applications to form our team for the 2013-2014 year. One truly unique aspect of our PRIDE
team is that we look for students from all nine high schools within Delaware County. We bring these bright, talented
and energetic students together to form one unified team. Please know that last year we received over 100
applications to fill a limited amount a spots; we expect the same response this year. Since we will most likely have
more applications than openings, please make sure your application and essay are completed thoroughly to give us
the best impression of who you are, your beliefs, and how you would be able to add to the success of the PRIDE team.
Please note even if you are brand new or have been on the PRIDE team before, everyone must complete a new
application form. Your character references will likely be contacted. Also, please note there is a $50.00 uniform fee if
chosen for the team. (Some scholarships are available upon request.)
Our timeline for the selection of the team follows:
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April 19th – PRIDE Application released
May 17th- Deadline to receive completed paper applications. Applications are due to Brandie Campbell at
the Delaware County Prevention Council office, 3595. N Briarwood Lane, Muncie, IN 47304
June 1st – Group Interviews
Week of June 10th Individual interviews
June 21st : Selection of PRIDE Team. –Students will be notified through the U.S. Postal Service with the
address provided on the application. Team selection will also be available on our website
(www.dcpreventionpartners.org) by midnight June 21st.
June 30- Parent Meeting.
Team events for June and July will be provided in the acceptance letter.
Again, thank you so much for your interest. We look forward to reading your application and essay. Outreach
Coordinator, Brandie Campbell, will call to set up interviews for those whose applications indicate they may fill a
need/opening on our team. During the actual interview, you will be asked to illustrate your talent to the committee.
If you have any questions regarding the application, the Delaware County PRIDE team, or the Delaware County
Prevention Council, please contact us at 765-282-7988 or Brandie 744.9859.
Good Luck!
Pat Hart
Executive Director
Brandie Campbell
Youth Outreach Coordinator
PRIDE Team Advisor
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2013-2014 DELAWARE COUNTY PRIDE TEAM APPLICATION
Sponsored by: The Delaware County Prevention Council
(Eligibility: High School Students in grades 9-12 from the following schools: Burris, Cowan, Daleville,
Delta, Muncie Central, Muncie Southside, Wapahani, Wes-Del and Yorktown)
“The Delaware County PRIDE Team is an organization committed to an alcohol, tobacco,
and drug-free lifestyle. Educating, promoting, and setting a positive example for the
community are the focus of our actions.”
Applications are due at the Delaware County Prevention Council by May 17th. Spaces are limited;
applicants selected for an interview will be called and then applicants selected for the team will be notified
of their acceptance in late June.
Please PRINT clearly in INK
Name: ________________________________________________ Sex: M F
Home Address:
Phone Numbers:
Birth date:
City: __________ Zip:
Home:
Cell:
School Name:
2013/2014 Grade Level: _____________GPA:_______________ E-Mail Address:
Do you have a Facebook or Twitter page (please include name it is listed under if different from
your actual name):
Parents/Guardians Name (s):
Have you attended any anti-drug or youth leadership conferences?
If so, list name of conference and year attended:
Do you participate in any school or community anti-drug efforts or groups?
If so, list what
What is your personal belief about teens using alcohol, tobacco, or other drugs?
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Explain why YOU would like to join the Delaware County PRIDE Team:
What characteristics do you have that would make you a good PRIDE Team member?
List any hobbies, talents, and interests you have:
Do you participate in any school sports or clubs? _______ if so, list them:
TALENT PORTION
If selected for an interview you will be asked to perform a talent, for example, dance, singing,
playing musical instruments, acting etc. We ask at your talent portion be no more than 2 minutes.
Due to limited space at the Delaware County Prevention Council no tumbling demonstrations will
be allowed. If your talent is tumbling or requires a lot of space please bring a video of you doing
your talent. We have a DVD player available for use, as well as a CD/MP3 player.
Please briefly describe the talent you will be performing if selected for an interview.
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ESSAY PORTION
ALL applicants are required to write an original and creative essay
of not more than 500 works on the topic:
“Why are my Footprints Worth Following”
What does this statement mean to you?
How do you portray this way of thinking in your everyday life?
When faced with challenges regarding drugs and alcohol, what do you do?
(Please note: You may use this page to write your essay or you may type your essay on another
page and attach it to your application.)
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CHARACTER REFERENCES
List 2 adults we may contact as Character References for you.
This could be a teacher, counselor, minister, employer, etc.
These should not be relatives.
#1 Reference Name: __________________________________ Phone: ______________________
_________________________
Occupation:
____
Relationship to you:
____
#2 Reference Name: __________________________________ Phone: ______________________
Occupation: __________________________________________________
_________________________
_______________
Relationship to you:
_____
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STUDENT PLEDGE/ PARENT AGREEMENT
Student, by completing this form, you are pledging to actively participate in planned drug
prevention activities and meetings throughout the year, especially assisting with the fall Red
Ribbon Campaign. You are also pledging that you will commit to an alcohol, tobacco, and drugfree lifestyle as a member of this group. All students chosen for the PRIDE team must also agree to
random drug testing throughout the year. Although a specific GPA is not required, good grades
are very important, and passing grades in all subjects are a must.
Student, please sign below AND have a parent and/or guardian also sign indicating their approval
and support for you to apply for the team. *Application MUST be signed by parent/guardian!*
Student’s Signature
_________
Parent/Guardian Signature
_________
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Date
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Date
IMPORTANT NOTE: Applications are due at the Delaware County Prevention Council by May
17th deadline. Spaces are limited; applicants will be called for an interview and then notified of
their acceptance in June. For questions, please call the Delaware Co. Prevention Council office at
282.7988 or Brandie 744.9859. Thank you for applying, and Good Luck!
Remit to:
Brandie Campbell, Youth Outreach Coordinator
Delaware County Prevention Council
3595 North Briarwood Lane
Muncie, IN 47304
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