Award Center License Application

Thank you for your interest in becoming an Award Center with The Duke of Edinburgh's International Award USA. We're excited to have you join the Award USA family!

Organization Information

Name of organization (as registered in legal documents):

Employer Identification Number (EIN) for your organization:

Official Address

City

State

Zip

Website:

Telephone #

What are the geographical boundaries of where you serve young people? Do you have jurisdiction over any subsidiary organizations or groups?

How long has your organization been in existence?

Have there ever been any lawsuits (etc.) brought against your organization or to an employee while representing the organization?

If so, please explain the nature of the lawsuit(s).

First name of the organization's authorizing official that will sign the license.

Last name of the organization's authorizing official that will sign the license.

Position of the organization's authorizing official that will sign the license (principal, executive director, etc).

Email Address of the organization's authorizing official that will sign the license.

Which category does your organization belong to:

Private/Commercial OrganizationGovernment/Public OrganizationNon-Profit with budget less than $250,000Non-Profit with budget between $250,001-$499,999Non-Profit with budget between $500,000-$999,999Non-Profit with budget more than $1,000,000

School Memberships (e.g. ECIS, IBO) or Affiliations to (e.g. Boy Scouts of America)

Approximately what percentage of young people in your organization identify as Hispanic/Latinx?

Racial/Ethnic Background of young people at your organization	Approximate percentage of young people in your organization that identify in this group

If the above racial and ethnic information is not collected at your organization, please write N/A.

Information about the proposed Award Program

How did you hear about the Award?

Why are you interested in delivering the Award?

Are there any staff members who have previously been involved in the delivery of the Award? Please provide any details about their previous involvement and training they have received.

Please note, at least two adults must receive training delivered by Award USA to be Award Coordinators. If you anticipate delivering your own Adventurous Journey or using other volunteers as Award Leaders or Adventurous Journey Supervisors or Assessors, they can be trained by Award Coordinators or Online through the Award Community online platform.

Name of Primary Award Coordinator.

Please note, this person will be treated as the primary contact for your organization.

Primary Award Coordinator Email.

Name of Secondary Award Coordinator.

Secondary Award Coordinator Email.

Will any other adults initially be involved in the Award as support? (e.g. Award Leaders, Adventurous Journey Supervisors and Assessors)

YesNo

How many other adults will initially be involved in the Award as support? Please also list names and positions of potential Award Leaders, Adventurous Journey Supervisors, and Assessors here.

If they are paid staff, how much time will be allocated for them to supervise the operation of the Award?

Is sufficient funding available to cover all costs (Annual License Fee, insurance--if not already covered, cost of training courses, etc.). Please explain further the source of funding.

Please provide the first and last name of the best contact in your organization for billing.

What is the email address for your billing contact?

What is the phone number for your billing contact?

When are you planning to start delivering the Award?

How many young people are you planning to start with at each level (Bronze, Silver, and Gold)?

Adventurous Journey and Gold Project Statement

All Award Operators (“AO”) that provide the Adventurous Journey (“AJ”) and/or Gold Project (“GP”) must do so through one of the following options:

Internal AJ or GP – The AO provides the Adventurous Journey and/or Gold Project through its own internal programs, in accordance with the guidelines for Adventurous Journey and Gold Project.
Activity Provider AJ – The AO offers the Adventurous Journey through an Activity Provider who has been licensed and trained by Award USA in accordance with a separate Activity Provider Agreement.
Third Party GP – The AO allows Award Participants to register for and attend a Gold Project that is operated and conducted by a third-party vendor.

Please check all that apply.

Internal AJ – Our organization intends to provide the Adventurous Journey to our

Award Participants, in accordance with the above.

Activity Provider AJ – Our organization intends to offer the Adventurous Journey via an

Activity Provider, in accordance with the above.

Internal Gold Project – Our organization intends to offer the Gold Project to our Award

Participants, in accordance with the above.

Third Party Gold Project – Our organization intends to allow Award Participants to register for and attend a Gold Project through another vendor, in accordance with the above.

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Safeguarding and Protection

Ensuring the interests and well-being of the young people served by Award USA is of the utmost importance. Please describe your safeguarding policies, youth protection procedures (including background checks and how frequently they are conducted), serious incident reporting policy, and your code of conduct. Please also see the Award USA Safeguarding Policy and Code of Conduct.

Please upload any of the above mentioned documents.

Indemnification, Insurance, and Risk Management

Award Centers must have appropriate insurance for delivering the training, practice, and qualifying components of the Award, including the Adventurous Journey and/or the Gold Project if they are not using outside providers. Please describe your comprehensive general liability insurance and summary of coverage, and dates of coverage.

Please describe any automobile liability insurance and summary of coverage.

Please describe any worker’s compensation/employer’s liability insurance providing protection against claims by employees or volunteers.

Please upload any relevant documents.

Page 6

Training Costs

Award USA offers online training that is $100 per person ..

Final Confirmation

By checking this box, I confirm that all the information given in this application form is correct and accurate to the best of my knowledge. I have read and accept the sample License and I am ready to sign the License as the basis of the relationship between my organization and The Duke of Edinburgh’s International Award USA.

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