Midwest- 2020-2021 Coach Host-Site Application Contact / Organization Information Midwest 2020-2021 Program YearPrior to filling out application, please ensure you are familiar with the details of the Up2Us Coach program. Read more here! OK Question Title * 1. Organization Contact Information Organization Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country OK Question Title * 2. Name of Person Filling Out Form Name Title/Role Email Address Phone Number OK Question Title * 3. Who will serve as Host Site Supervisor (this is the person who will oversee and directly supervise your coach/es)? Name Title/Role Email Address Phone Number OK Question Title * 4. How did you hear about this Call for Partnerships? OK Question Title * 5. Program Information: Mission OK Question Title * 6. Program Information: up to 8 sentences describing organization's key programs, accomplishments, and history. OK Question Title * 7. How long has the organization been in operation? OK Question Title * 8. Top Five Funders: Funder Funder Funder Funder Funder OK Question Title * 9. Organization's annual budget: OK Question Title * 10. Number of paid staff: Full time Part time OK Question Title * 11. Participant demographics: Percentage of youth served who have physical and/or mental disabilities. Percentage of youth served who qualify for free/reduced price lunch programs. Gender breakdown of youth served (example: 45% female, 53% male, 2% other). Age range of youth served. Number of youth served across all programing activities. Percentage of youth served who are youth of color. OK Question Title * 12. Does your organization require a fee for youth participation? Yes No OK Question Title * 13. If yes, do you provide a sliding scale or scholarships for participation? Yes No OK Question Title * 14. Are you: A first-time host site (applying for coaches for the first time or have never been awarded coaches before). A current or previous host site (have applied for and been awarded Up2Us Sports coaches in the past). OK NEXT