Youth Ambassador Application

Youth Ambassador Program Information & Application

Thank you for your interest in becoming a part of the Tourette Association of America’s Youth Ambassador Program!  Please apply below. 

  • For Youth Ambassador Applicant:

  • Please complete and sign this application, and don’t forget to have your parent/guardian sign as well. Application must be completed by the Youth Ambassador applicant.
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  • Please answer the next four questions to the best of your ability by indicating whether you Strongly Agree, Agree, Disagree, or Strongly Disagree in the statements below. These questions are general in nature and will not influence whether you are chosen to be a Youth Ambassador.
  • Please note: If you are chosen to become a YA, this information will be displayed publicly.
  • Please note: If you are chosen to become a YA, this information will be displayed publicly.
  • Max. file size: 100 MB.
  • Max. file size: 100 MB.
    Tell us in your own words why you want to be a Youth Ambassador and what being a Youth Ambassador means to you. Please include your name, age, and the state you live. You can also email video to [email protected] and include the subject line as Youth Ambassador Video Submission Please note: If you are chosen to be a YA your video may be displayed publicly.
  • My Story

    Tell us your story and what you want people to know about you. What would you want the outside world to know about Tourette Syndrome? Please be sure to mention the following points:

    • Tell us about your experiences with TS
    • Do you, or someone you know, have a diagnosis of TS?
    • Have you had any experiences telling people you have TS? Please explain.
    • What experiences have you had with other people’s reactions to TS
    • How do you see yourself as a representative for Tourette Syndrome?
    • Why do you think you would be a responsible/effective Youth Ambassador?
    • Please also tell us what you would like to achieve by being a Youth Ambassador?
    • How do you envision the YA program having an impact in your life in 5-10 years?

    Please note: If you are chosen to be a YA, your story will be displayed publicly. Also, note that Youth Ambassador stories will be edited and the final product may not be in the same format or contain all of the components submitted to the TAA.
  • Max. file size: 100 MB.
  • For Parent/Guardian:

  • I have read the “Youth Ambassador Requirements” and am aware that my child is applying to be trained as a Tourette Association Youth Ambassador.
  • If this application is accepted and my child is selected to attend Youth Ambassador Training at the Kellogg Conference Hotel in Washington, D.C., I understand that, as the guardian/parent who will be chaperoning my child, I am responsible for supervising my child at all times, including the time my child spends at the Kellogg Conference Hotel and any times when my child leaves the hotel for any reason including to attend Advocacy Day on Capitol Hill (if plans are changed and Advocacy Day is held in person). The event is being held in Washington DC, as such my child and I need to be aware of our surroundings at all times when outside of the hotel.
  • If this application is accepted for attending the Youth Ambassador Training as an Additional Team rather than the Funded Team (please see Youth Ambassador Training Information Sheet), I understand that we will be responsible for all costs of the Training, including Training fees, travel, lodging and incidentals, and other program costs and materials.
  • Media Participation Release
    I hereby irrevocably grant to the Tourette Association of America and to its employees, agents, and assigns, the right to photograph and/or video record and use pictures, silhouettes, videos and other reproductions of me and/or my children’s physical likeness (including potentially televised both locally and nationally) for educational, informational, promotional, charitable and fundraising activities for the Tourette Association and its Chapters and Support Groups and inclusion on, but not limited to the Tourette Association’s website, YouTube Channel and all other social media sites. I hereby certify and represent that I have read the foregoing and fully understand the meaning and effect thereof and, intending to be legally bound, I have hereunto set my hand.
  • I have read the application in its entirety and understand the time commitment to prepare and train for the Youth Ambassador Training & Program.