2015 Coaches’ Challenge Outstanding Match Nomination Form Due: September 4, 2015
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Outstanding Match Nomination Form – KSU Football Game Nominate a match to attend the football game on October 10, 2015 To promote the 2015 Coaches’ Mentoring Challenge and to recognize AMAZING matches in Kansas, Kansas Mentors would like to invite 2-3 matches to attend the Kansas State Wildcats (KSU) vs. Texas Christian University (TCU) football game in Manhattan, KS on October 10, 2015 to participate in an on-the-field recognition ceremony. Mentoring programs are encouraged to nominate an outstanding mentoring match for an opportunity to attend the October 10th football game and be recognized. 
Coaches’ Challenge Overview: MENTOR: The National Mentoring Partnership’s report, The Mentoring Effect, found through the first nationally represented survey of young people that one in three will grow up without connecting with a mentor. The survey also found a powerful mentoring effect demonstrated by the experiences of young people who participated in the survey. It is linked to improved academic, social and economic prospects, and strengthens our communities and our nation. As just one example of the report findings, at-risk young adults who had a mentor are 55% more likely to be enrolled in college than those who did not have a mentor. For the past seven years, college coaches and an increasing number of institutions, who know first-hand the impact of this powerful asset, have demonstrated their commitment to closing the mentoring gap by participating in the Coaches’ Mentoring Challenge. This campaign began as a friendly competition between Coach Tom Osborne at the University of Nebraska and Coach Bill Snyder at Kansas State University, in 2008, with the goal of rallying new volunteers for mentoring programs in their communities and states. Since its kickoff, teams in seven states have joined and during the 2014 Coaches’ Mentoring Challenge, over 10,000 new mentors stepped up. The 2015 Coaches’ Mentoring Challenge kicks off on August 1 and runs through November 30, with results being released during the first week in December. Through this effort, participating coaches and universities are making meaningful contributions to the communities they call home. A complete nomination application must include copies of the following: Nomination Cover Sheet – page 3 Waiver of Availability (Mentor & Mentee) – page 4 Publicity Consent and Release Agreement (Mentor & Mentee) – page 5 & 6 Nomination Narrative – see instructions on page 2 Nomination Narrative: (Please limit your entry to 500 words) Discuss how the mentor and mentee’s lives have been changed throughout the match. Please share any highlights from the nominee’s mentoring relationship. These can include obstacles or challenges that the nominees have overcome, or they can be positive and inspirational experiences. Please submit at a photo of the match-either in action or posed-digitally to mentor@ksde.org Award Rules: Completed applications must be received by Friday, September 4, 2015 at 4:00PM; applications received after this time will be disqualified. All programs will be notified electronically by Friday, September 10, 2015 of their selection status. Applications will be selected by the applicant’s ability to successfully verbalize the merit of the match based on the selection criteria. Mentoring matches must be nominated by a community, school or faith based mentoring program; programs are limited to one nomination per organization, per opportunity. Programs must complete all portions of the nomination form including submitting a digital picture to be eligible; incomplete applications will automatically be disqualified. Eligible nominating programs must: Be registered as an Affiliate Program by September 4, 2015 with Kansas Mentors. To view a list of registered programs visit: www.kansasmentors.org While eligible applicants do not need to be categorized as a Gold Star program prior to September 4, 2015, those that are will be given priority. Agree to participate in the 2015 Coaches’ Challenge by submitting new mentor totals at the end of each report period (August, September, October, November). Completed applications may be submitted electronically to: mentor@ksde.org. This event will take place on Saturday, October 10, 2015 (time TBA). Eligible recipients will need to be available for travel to Manhattan. Time of arrival will be determined based on game time (game time has not been announced yet). Kansas Mentors is NOT responsible for match’s travel to Manhattan. Kansas Mentors reserves the right to consider historic information and fact, whether gained from the application, question and answer conferences, references, or any other source, in the application review process. Questions may be directed to Cheri Faunce at 785-368-6211. Nomination Cover Sheet (to be completed by the nominating program) MENTORING PROGRAM INFORMATION
Are you registered as a Gold Star mentoring program with Kansas Mentors? __ YES __ NO Please note that if your program has a policy that might prevent a match from your organization to travel and/or attend such an event, we will allow an appropriate staff member from your program to supervise and therefore attend the event. In the event that this applies to your organization, please submit documentation of your policy and provide the name and contact information of the assigned staff member. __No, this does not apply to our program __Yes, this applies to our program
MENTORING MATCH INFORMATION Please complete contact information (address, phone) for Mentor only. If selected, this information will be used to contact the mentor regarding the filming logistics.
Nomination Packet Complete? Have you included (in this order): Nomination Cover Sheet – page 3 Waiver of Availability (Mentor & Mentee) – page 4 Publicity Consent and Release Agreement (Mentor & Mentee) – page 5 & 6 Nomination Narrative – see instructions on page 2 Digital picture sent to mentor@ksde.org Waiver of Availability Please obtain signatures of the nominees, which indicate the nominees are aware their names are entered for this award and signify their agreement to attend and be a part of the 2015 Coaches’ Challenge event at the Kansas State game on October 10, 2015. Mentor signature: _____________________________________________________________ Name Date Mentee signature: _____________________________________________________________ Name Date Mentee’s parent/guardian signature: _____________________________________________________________ Name Date P MENTOR’S RELEASE ublicity Consent and Release Agreement Individuals/mentors/mentees/students/minors are occasionally asked to be a part of the Kansas Mentor publicity, publications and/or public relations activities. In order to guarantee their privacy and ensure their agreement for participation, Kansas Mentors asks that this form be signed. The form referenced below indicates approval for their names, portraits (video or still) and words, to appear in Kansas Mentors videos or on Kansas Mentors Web sites. These pictures and articles may or may not personally identify the individuals/students/minors. The pictures, videos and/or words may be used by Kansas Mentors in subsequent years. Agreement I release to Kansas Mentors my, or the minor’s child name, portraits (video or still) and/or words and consent to their use by Kansas Mentors. Kansas Mentors agrees that the name, portraits (video or still) and/or words shall only be used for any public relations, public information, publicity, Web sites and instruction. I understand and agree that: No monetary consideration shall be paid; Consent and release have been given without coercion or duress; This agreement is binding upon heirs and/or future legal representatives; The name and portraits (video or still) may be used in subsequent years. Effective Date of Agreement : __ __ /__ __ / __ __ __ __ If you wish to rescind this agreement you may do so at any time with written notice. Name: ____________________________________________________________ (Print Name as you wish it used) Written Signature: _______________________________________________ Status: ______________________ (Parent or legal guardian sign for minor) (Father, Mother, Guardian, etc.) Witness: __________________________________ Written Signature: ___________________________________ (Kansas Mentors or Mentoring Program Employee, Print Name) P MENTEE’S RELEASE ublicity Consent and Release Agreement Individuals/mentors/mentees/students/minors are occasionally asked to be a part of the Kansas Mentors publicity, publications and/or public relations activities. In order to guarantee their privacy and ensure their agreement for participation, Kansas Mentors asks that this form be signed. The form referenced below indicates approval for their names, portraits (video or still) and words, to appear in Kansas Mentors publications, videos or on Kansas Mentors Web site. These pictures and articles may or may not personally identify the individuals/students/minors. The pictures, videos and/or words may be used by Kansas Mentors in subsequent years. Agreement I release to Kansas Mentors my, or the minor’s child name, portraits (video or still) and/or words and consent to their use by Kansas Mentors. Kansas Mentors agrees that the name, portraits (video or still) and/or words shall only be used for any public relations, public information, publicity, Web sites and instruction. I understand and agree that: No monetary consideration shall be paid; Consent and release have been given without coercion or duress; This agreement is binding upon heirs and/or future legal representatives; The name and portraits (video or still) may be used in subsequent years. Effective Date of Agreement : __ __ /__ __ / __ __ __ __ If you wish to rescind this agreement you may do so at any time with written notice. Name: ____________________________________________________________ (Print Name as you wish it used) Written Signature: _______________________________________________ Status: ______________________ (Parent or legal guardian sign for minor) (Father, Mother, Guardian, etc.) Witness: __________________________________ Written Signature: ___________________________________ (Kansas Mentors or Mentoring Program Employee, Print Name) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
