Diller Teen Awards

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Page 1 - Background Information

The Diller Teen Tikkun Olam Awards recognize Jewish teens in the United States who have demonstrated remarkable leadership and initiative in projects that embody the values of tikkun olam , “repairing the world."

Directions:

All application questions should be completed by teen applicants.

We recommend drafting and saving long form answers prior to submitting online.

Please see this .pdf file of the application.

For more information or support: [email protected].

To use the Save and Resume feature

Before saving your form, please make sure you have filled out each of the four fields in this section. Then you can use the "Save my progress and resume later" feature. Please make sure to note your password so you can easily access your saved form.

First Name:

Last Name:

Email:

State:

Other:

Eligibility

If you can answer "yes" to the following 4 questions, you are eligible to apply for the award. Teens are not eligible for the Award if they have a sibling who has received a Diller Teen Tikkun Olam Award in the preceding five years.

Will be aged 13-19 years old on January 8, 2020?

YesNo

Are a resident of the US?

YesNo

Have not been compensated for work on your project

YesNo

Self-identify as Jewish?

YesNo

In what way do you identify as Jewish? (We are not looking for a particular answer--Jewish connection takes many forms.):

Your Information

Tell us about yourself (a short personal bio):

Birthdate:

Home Phone:

Cell Phone:

Parent/Guardian Names, First Last:

Street Address:

City:

Zip:

School Name:

School's City, State:

Year in School:

Page 2 - Project Information

Please note the varied word limits indicated for each question, which are tracked for you by the word counter below the field.

About Your Project

Project title:

Imagine you have 30 seconds to explain what your project accomplishes and who it serves. What are the key points you would make?

How did your project begin? What/who inspired you to take action?

What outcomes do you work to achieve through your project (please be as specific as possible)?

What are the programs/activities/events/methods used to reach your outcomes(s)?

Goals/Metrics

Please briefly describe the impact of your project (a list or short phrase is sufficient):

The project goals you've met:

The social issues you've addressed:

The approximate number of people served:

The approximate number of volunteers engaged (if relevant):

The number of other project leaders (if there are other leaders):

Any website/social media metrics:

Please describe your project's impact to date (include how those you serve are affected and changed by your project/work).

Leadership

Please describe your leadership role in this project. What are your specific leadership responsibilities?

What is your leadership title:

What motivated your leadership on this particular project?

Do you manage others?

YesNo

How many others do you manage?

What form does that management take?

What are the roles of those you manage?

How have you grown as a leader through this project?

What do you envision for your project going forward? Please include any plans you have to hand off leadership. If you do not have such plans, explain why they are not yet necessary.

Please describe your most notable accomplishment while working on the project:

Please describe one or more challenge you have faced while working on the project:

Project Background/Origin

Are you the project:

FounderCo-FounderLeaderCo-LeaderSupporting Leader

Teens who have created and co-led with others are welcome to apply individually for the Tikkun Olam Award. In such cases, each applicant will be considered and evaluated separately, and no more than one applicant can be selected as an award recipient.

What is the co-leader's title and specific responsibilities?

Please provide name, phone number, email of co-leader:

Is the co-leader Jewish and also eligible for the Award?

YesNo

Did you and your co-leader create/start the project together?

YesNoOther

Please describe co-creation:

Does your project primarily:

Facilitate events/programsFundraiseLead advocacy initiativesManage a website/online platformProvide curriculum (please include attachment below)Provide supplies/resourcesRaise awareness for an existing organizationRecruit/manage volunteersOther

Other function, please describe:

Do your project's programs/activities/events/methods primarily take place (select all that apply):

In-personVirtuallyOther

How many in-person events have you held

Other location, please describe:

Did your project/leadership build off of an already existing project?

YesNo

What is that existing project's name

Does your project have a parent organization or any other organizational affiliations?

YesNo

What is that parent/affiliated organization's name?

Describe organization name/role:

Is your project dedicated to raising funds/ volunteers/ resources/ awareness for an existing organization?

YesNo

What is that organization's name?

Was your project created as a Bar/Bat Mitzvah project?

YesNo

Length of Project

When did you begin leading your project?

MM/DD/YYYY

How much time do you spend on your project?

(hours per week)

Hours Spent Period

Per WeekPer MonthPer YearSince Inception

Support/Engagement of Others

How do you engage other young people?

Many teens leaders are assisted by others in bringing their projects to life and/or making them successful. Responses from leaders working as individual contributors as well as within participatory groups are welcome:

How are you supported by others?

Do others (adults or teens) have a role in managing this project?

YesNo

Please describe the key people supporting the management of your project.
For each person, include the name, teen or adult, their relationship to you and a few details about their role.
For example: Ruth Bader Ginsburg, friend, mentor, staff writer - sends communications, emails, etc.

Finances, Donations, and Accounting

Did/do you raise funds to support this project?

YesNo

What amount have you raised to date?

How are finances managed, and by whom?

Did/does your project have expenses?

YesNo

How much money has been spent, and what has it been spent on?

Attach budget, if applicable:

Ex.) .doc, .docx, .xls, .xlsx, .csv, .pdf, .jpg, .jpeg, etc. Google drive attachments not compatible.

Did/do you receive donations of goods or services?

YesNo

Please describe goods or services donated:

Have you used any of the items noted above, or given them to other individuals/organizations? Please describe:

Have you, or has anyone involved in your project, been compensated for work done in relation to the project?

YesNo

What was the amount of compensation, to whom, and what was it for?

Page 3 - Additional Information

Outside Volunteering / Additional Information

If you have done community service/tikkun olam volunteering not related to your project, please describe the nature, length, and goals of that volunteering:

Please share any additional information you would like the selection committee to know about you and your project leadership.

Project website:

If not applicable, write N/A

Please share handles/links to any social media pages or webpages created specifically for your project:

If not applicable write N/A

Optional: If you feel there are other links important to consider along with your application, such as news articles, you may include those here.

Additional Documents (Optional)

If you feel there are other materials you would like the committee to consider along with you application, please include those here. Accepted formats include: .doc, .docx, .xls, .xlsx, .csv, .pdf, .jpg, .jpeg, .png. Google drive attachments not compatible.

It is often helpful to see fundraising/budgeting spreadsheets, news articles, etc. If you plan events or offer a curriculum, please include event schedules and key curricular materials.

Attachment(s) must include your name in the document title so we are able to link it to your application.
Please save the document as "your full name -short description"
- For example: "Golda Meir - Curriculum"
Your short description should not exceed twenty-five characters.

Additional Uploads1

Additional Uploads2

Additional Uploads3

Additional Uploads4

Additional Uploads5

Demographic Information

Synagogue Name, if any:

If not applicable, write N/A

Synagogue City, State, if any:

If not applicable, write N/A

Please list the name, city, and state of any Jewish organizations and institutions with which you've engaged (such as a Jewish Day School, Camp, Youth Group, etc.)

If not applicable, write N/A.

References

All applicants must provide the names and contact information of three people who know and can speak to your leadership within your project.

Please list the individuals after you have their permission. We MAY contact all or none, to provide a confidential reference.

Note: In some cases, staff may contact you or others familiar with your project for additional information.

Have you been nominated to apply?

YesNoAll applicants are weighted equally, with or without a nomination.

Reference 1

Reference 1 First Name:

Reference 1 Last Name:

How they are connected to you/your project (role, relationship):

Email:

Phone:

Reference 2

Reference 2 First Name:

Reference 2 Last Name:

How they are connected to you/your project (role, relationship):

Email:

Phone:

Reference 3 (if not nominated)

Reference 3 First Name:

Reference 3 Last Name:

How they are connected to you/your project (role, relationship):

Email:

Phone:

Nominator (if nominated)

Nominator First Name:

Nominator Last Name:

How they are connected to you/your project (role, relationship):

Email:

Phone:

Miscellaneous Information

Your answers to questions in this section are for office use and will not be forwarded to the committee.

Where did you hear about the Diller Tikkun Olam Awards? (Select all that apply):

TOA Ambassador	Past Recipient	Another Nominee
Nominator	Scholarship Posting	Colleague or Friend
Email from Program	Social Media	Local Jewish Organization
Jewish News Story	Web Search	Print Ad
Online Ad	Mailing from Program	Other News Story
Podcast Ad	Other

Please specify (Ex: Name of website, Name of person):

Confirmations

By checking this box, I agree to receive communications via text about my application. Standard message & data rates apply. Text STOP to 31996 to stop.

YesThe Diller Teen Tikkun Olam Awards will only text regarding the completion of this application.

By checking this box, I confirm that I completed this application myself and the above information is accurate to the best of my ability:

Yes

By checking the boxes below, I confirm that, if selected as a recipient, I accept the following requirements:

I will attend the awards events in San Francisco August 2020.

Yes

I will be available during June and July to be videotaped or submit footage for the Diller Teen Tikkun Olam Awards recipient video.

Yes

I will periodically provide brief updates and contact information (email, cell, address, etc.) to the Helen Diller Family Foundation subsequent to receiving the award.

Yes

I will use the award money either to further my tikkun olam work or for my education.

Yes

You will receive a confirmation email upon submission.

If you do not receive an email, please recheck that this form has no error alerts and contact us at 415-512-6432 before navigating away from this page.

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2020 Diller Teen Tikkun Olam Awards Application

Page 1 - Background Information

Page 2 - Project Information

Page 3 - Additional Information

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2020 Diller Teen Tikkun Olam Awards Application

Page 1 - Background Information

Page 2 - Project Information

Page 3 - Additional Information