Rising Leader Application

Requirements: To apply for the Youth Ambassador Rising Leaders Program, it is required that you have been a trained Tourette Association Youth Ambassador for one full year (trained in 2021 or prior) or that you are a young adult who has demonstrated dedication to spreading awareness on TS. Please note the Youth Ambassador Rising Leaders Program is for young adults aged 18-25 years old. Parents are not expected to attend the training.
Name:*
First Last
Date of Birth:*
MM slash DD slash YYYY
Age:*
Are you a Youth Ambassador?*
If yes, what year were you trained?
Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone:*
Email:*
Education (if you are a student, please list College and Major):*

N/A if not applicable
Occupation:*

N/A if not applicable
Gender:*
Ethnicity/Race:*
How did you hear about the TAA RL Program?*
Do you have a diagnosis of Tourette Syndrome?*
Do you use social media? If so, what are your handles?
Facebook
Instagram
Twitter
Other
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 Rising Leader.
1. I am excited about what the future holds.*
2. I feel that I have all the tools I need to go out in the community and make presentations about TS.*
3. I feel comfortable sharing my story with groups of people in my community, including public officials.*
4. I plan to go to college or to a trade school/program after I graduate from High School. Please also answer the following related question.*
4a. If strongly agree or agree, please share your plans regarding on campus or off campus living and why.
4b. If disagree or strongly disagree, please explain why and tell us what your post HS plans are.
5. Do you have any previous involvement with a local TS Chapter and/or Support Group? If so, please describe.*
6. Have you done any in-person or virtual presentations on TS? If so, to what age groups and what type of groups?*
Please include age groups and types of group settings.
7. If applicable, please include the link to any news media or article written about you or a video of you spreading information about TS:*
Website
File
Max. file size: 10 MB.
8. Please describe any hobbies or interests you have:*
9. What are some difficult questions you have received about Tourette Syndrome and how do you answer them?*
10. Have you volunteered for any other organizations? If so, which ones and please describe your role?*
11. Why do you want to be a Peer Mentor to youth with Tourette Syndrome? What type of Peer Mentor do you think you would be?*
12. What personal experiences, skills or qualities do you think might assist in your success or ability to mentor youth with Tourette Syndrome?*
Personal Statement: Please provide a 1-2 page, single-spaced, size 12 font, personal statement telling us about your experience with Tourette Syndrome. This is your opportunity to share with us your involvement in the Tourette community and how it has impacted your life thus far. Please include the following points:
- •Have you had any experiences telling people you have TS (positive or negative)? If so, what were their reactions? Please explain.
- • Describe a time you overcame a problem or difficult time, as it relates to TS, and what helped you overcome it.
- • What do you think it means to be a Tourette Association Youth Ambassador Rising Leader?
- • Why do you want to be a Tourette Association Youth Ambassador Rising Leader?
- • Describe the strengths you will bring to RL program.
- • Describe the strengths you will bring to the RL program.
- • How do you envision the RL program impacting your life 5 – 10 years from now?
Please note: If you are chosen to be a RL, your story will be displayed publicly.
Please upload your Personal Statement.*
Max. file size: 10 MB.
Please upload a photo which the Tourette Association may use for print materials.*
Max. file size: 10 MB.
Please upload your current resume.*
Max. file size: 10 MB.
We encourage you to list an academic or professional reference. References may be contacted.*
Must include: Name, Relation to Applicant, Phone, Email.
Shirt Size*
- Small
- Medium
- Large
- X-Large
- Other
Do you belong to a local TAA chapter?*
Please initial the following:
I have read the “Tourette Association Rising Leader Program Requirements.”*

Initial
I grant permission to the Tourette Association to use my name, hometown, picture and other pertinent information:*

Initial
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.*

Initial
I have read the application in its entirety and understand the time commitment to prepare and train for the Rising Leaders Training & Program.*

Initial