Tell us about your leadership activity!

Name*

First Last

Agency Name and Number*

Email*

Mentor or Unified Partner Name*

Can we add you to our Athlete Leader Facebook group?

Yes
No

If yes, what is your Facebook URL?

Which workshop is this activity related to?*

Are you currently coaching?

Yes
No

What sport(s) are you coaching?

Why aren't you currently coaching?

I decided I didn’t want to be an athlete coach
There is not a need for an athlete coach right now
I haven’t done my Class A registration and Protective Behaviors training
I haven’t done the coaches certification

Check any activities in which you have taught others about health:

Gave a presentation or speech
Helped with a Healthy Habits Education Station at a local or regional competition
Volunteered at a Healthy Athletes state event
Led warm-up exercises at a practice
Worked on your own fitness and health goal(s)
I am not serving as an Athlete Health Leader right now

Which fitness and health goal(s) have you worked on?

Weight loss or improved nutrition
Drinking more water and less soda
Exercising more times a week
Getting a good night sleep
Stress management

Why aren't you currently serving as an Athlete Health Leader?

Check any events in which you have served as a table official:

My local program’s scrimmage
A local invitational
A regional tournament
The State Indoor Sports Tournament (IST)
I’m not serving as a table official for basketball right now

Why aren't you currently serving as a table official?

Have you given a speech?

Yes
No

What was the name of the event?

What was the date of the event?

How many people were at the event?

What was your speech about?

Did you create or join a local Athlete Input Council?

Yes
No

When does your Council meet?

What projects is the Council working on?

Why hasn't a local Athlete Input Council been created yet?

Is there anything SOWI can do to help?

Additional comments (optional)

Special Olympics Wisconsin
6582 Ronald Reagan Ave.
Madison, WI 53704
	(608) 222-1324

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