Youth Application for the Youth Ambassadors Program 2017

Transcription

1 Youth Application for the Youth Ambassadors Program 2017 Selected participants will travel to Washington, DC and a host state for about four weeks during September-October, 2017 and will have the opportunity to: Appreciate similarities and differences between the U.S. and Venezuela; Learn about U.S. history, culture, politics, environment and language(s); Develop the skills needed to be a positive leader in your community; Explore societal challenges and create a service project for your community; Connect to a network of volunteers/community leaders including other youth throughout the hemisphere. Applicants must meet the following requirements in order to participate: 1. Be between years old during dates of travel; 2. Currently enrolled in a high school and have at least one semester remaining after October 2017; 3. Good academic standing; 4. Display leadership qualities and potential; 5. Have volunteer experience and a real commitment to serving others; 6. Be able to communicate effectively in English; 7. Be a citizen of Venezuela; 8. Have little to no previous travel experience to the U.S. Applications will be accepted no later than April 30. We highly recommend submitting your application hours or days in advance to avoid any technical issues timely submission. Note all applicants must only submit one application through either mail or online. Do not submit your application both online and through mail. Partners of the Americas, with US State Department funding, will pay all expenses related to participation in the program including domestic and international flights, meals, accident and sickness protection, required vaccinations, some spending money, and lodging. Complete the following application in English and submit the required materials listed below through this online system or by completing this PDF application then scanning and ing the application with all required attachments to CaracasExchanges@state.gov and companerosdevenezuela@gmail.com by April 30, Required attachments: 1. Submit a copy of your completed application form; 2. A legible copy of your identity card; 3. A legible copy of the bio-data page of your valid passport; 4. Certificate of Registration in the current school period issued by your school authorities; 5. A copy of your school record/grades for ; 6. A legible copy of a recibo de servicio público that proves your residence; 7. 5 x 5 cm Photograph of full face in color with white background; 8. Letters of recommendation in Spanish from your school and an organization where you volunteer that provide information about why the applicant should be selected; 9. Personal financial balance of your parents; 10. Parents authorization to apply for the program. Send questions to CaracasExchanges@state.gov and companerosdevenezuela@gmail.com.

2 Participant s Personal Information First name Middle name Last names Gender Identity (M, F, Other) City, state/department of birth Date of birth AND age Occupation Home/Cell-phone Nº address Complete home address (write in Spanish and include your state/department) Venezuelan ID No. Educational Data 1. Name and full address of the school where you study in Spanish (include city and state): Indicate if your school is public or private: 2. Current grade in high school (e.g. 3 rd, 4 th, etc.) and GPA (e.g. 17/20). Attach a copy of your school record the current year: 3. Have you participated in a U.S. Embassy sponsored program such as Access or College Horizons? No Yes If yes, in which program did you participate? 4. Did/do you study English in a language school? If so, please provide name and address of school in Spanish (attach a copy of your school record for the current year): Previous travels abroad: To the United States: No Yes To other countries: No Yes If yes, where and when and indicate if countries visited are of family origin:

3 Medical Restrictions (if any, please specify and indicate type of medication used): What is the level of your conversational English: Basic Medium High How long have you studied English? Please describe your talents, virtues, and goals/dreams. Tell us about your ideas/interests for a future service project in your community.

4 Participant: Volunteer/Social Initiative Describe any volunteer service work experience you have and please include the duration of each example. Leadership Experience Please describe your leadership experience and include lessons learned. What areas of your leadership do you think you can improve? (We recommend that you ask a teacher, mentor or coach in order to best respond).

5 Interest in the Youth Ambassadors Program Describe why you want to become a Youth Ambassador and provide specific ways in which you would apply what you learn in the program to address particular community issues. (Please write it in Spanish) Family Information Parents: Married Separated Deceased Mother Deceased Father Family size: Number of Brothers: Number of Sisters: Number of family members living with you in the same house: Who do you live with: Parents Mother Father Other (specify): First and middle name Last names 1 st Parent s Information Occupation and employer (name of) Level of Education (Primary, secondary, university or graduate studies) Current address including city and state (please write it in Spanish) Home phone Office phone Cell phone 1 st Parent s Venezuelan ID No.

6 First and middle name Last names 2 nd Parent s Information Occupation and employer (name of) Level of Education (Primary, secondary, university or graduate studies) Home address including city and state (please write it in Spanish) Home phone Office phone Cell phone 2 nd Parent s Venezuelan ID No. Applicant Signature By signing below, I understand that as a Youth Ambassador, I will be expected to participate in all program activities, including orientation meetings, follow-on activities and project implementation (print name) (fecha) Autorización parental: Por medio de mi firma autorizo que mi hijo/a solicite participación en el programa Jóvenes Embajadores 2016 Madre/Padre/Tutor(a): (nombre completo) Madre/Padre/Tutor(a): (nombre completo) (fecha) (fecha)

7 Youth Ambassadors Program 2017 Biographical Information Sheet Full Name Age & Gender Hometown and state Hometown High School Favorite School Subjects Attach a recent and clear color photo here or upload photo if applying online Hobbies/interests Future goals and dreams Volunteer activities Tell us about unique ways in which you would like to help improve your community/state/country Why do you want to be a Youth Ambassador? * For selected youth, information from this form will be sent to your host family in the U.S., to the US Department of State and other partner organizations.