Sugt sturllinaq Nupuglluta: We Only Speak Sugt stun A language immersion camp to be held in Port Graham, Alaska July 28 through August 8, 2014

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1 Sugt sturllinaq Nupuglluta: We Only Speak Sugt stun A language immersion camp to be held in Port Graham, Alaska July 28 through August 8, 2014 Camp Application Packet Applications Due: June 30, 2014

2 Application Student s Name: Sugt stun Name School: Student Grade: Birth date: Address: 1. Tell us why you would like to attend the Language Immersion Camp: 2. What do you hope to learn at the Language Immersion Camp: 3. List your 3 cultural activities you like to do with your family/friends etc fishing, hunting: 4. How do you like to spend your free time? 6. Think of someone you admire. List the reasons you admire this person: Provide 2 References from your community who would recommend your attendance at this camp. Name: Name: Title: Title: Address: Address:

3 Application Scoring Guide Parent Supplement (Completed by parent) Student s Name: Parent s Name: 1. Tell us a little about your child! Please tell us something that will help us know and understand him or her better. 2. Are there any additional challenges or issues of which we should be aware?

4 Expectations and Travel Eligibility To be reviewed, understood, and signed by all participants. BEHAVIORS AND EXPECTATIONS Immersion camp students are considered a representative and ambassador for their school, teachers, family, community and self. They are expected to conduct themselves in a responsible and mature manner at all times. We strive for excellence at Anchorage House and expect excellence from each participant. VISITATION Immersion camp is a very important cultural activity. Written approval is required by a parent or guardian to be checked out by another family member. YOU MUST LET AN ADULT KNOW WHERE YOU ARE AT ALL TIMES! FACILITY MAINTENANCE House chore assignments will be selected/assigned, and are mandatory. All meals are to be prepared and eaten at the camp facility. Furnishings are to be treated with care and any damage should be reported to a staff member immediately. CHANGING ROOMS /QUIET HOURS Room assignments do not change. Students are required to be in their rooms by 10:00 pm. Lights out, is at 10:30 pm. Unless there is a late group activity taking place. After lights out, students must remain on their floor until breakfast time. THEFT The loss of money or personal property due to theft is always a threat. Chugachmiut is not responsible for replacing lost or stolen items. PERSONAL PHONE USAGE Phone usage will be limited to evenings. Phone calls will need to be under ten minutes and limited to family members only. MEDICATION All prescription medications must be turned in to the Anchorage House staff. Meds will be logged and administered by the staff. NON-NEGOTIABLES: The consumption or possession of alcoholic beverages, controlled substances or use of tobacco Not informing a staff member of your whereabouts Inappropriate use of the internet and computers Leaving your floor at night for non-emergency situations Disrespecting students, staff or purposely damaging facilities Refusing to turn in personal computer and cell phone when asked Body piercing, hair dyeing, tattoos, etc. during Chugachmiut activities Bringing weapons to Chugachmiut activities, including any kind of knife, etc. PDA s Public Displays of Affection Willful violation of any non-negotiable rule will result in automatic and immediate dismissal from the program with an expedited return home at your parent or guardian s expense.

5 TRAVEL ELIGIBILITY Any student who cancels travel plans in a time frame that does not allow time to find a replacement or to regain the costs of travel, will be ineligible to travel until Chugachmiut has been reimbursed. In the event that a student violates any non-negotiable rules or codes of conduct while participating in a Chugachmiut sponsored program, they will be sent home immediately at their expense. In order to regain eligibility for immersion camp and other opportunities within the same program year the violation occurred, the student must meet the following criteria: 1. Formally apologize to the staff and participants or program affected by the student s behaviors. 2. Chugachmiut has been reimbursed for any travel expenses incurred by sending the student home early. In order to regain eligibility to participate in Chugachmiut funded programs sponsored by Chugachmiut, the student must meet the following criteria: 1. Complete steps listed above for eligibility to travel to Chugachmiut sponsored events. 2. Demonstrate appropriate conduct at all sponsored events that involves travel. I have read and understand these rules and agree to abide by them. I also understand that willful violation of these rules may result in my immediate dismissal from the program and expedited return home at my parent or guardian s expense. Student s Signature: Date: Parent s Signature: Date:

6 Student & Parent Travel Agreement Student's Name: Date: As a participant of a Chugachmiut sponsored activity, which requires travel, I agree to the following: 1. Student will represent my community and tribe in a mature, responsible manner at all times. 2. Student will not use or have in my possession drugs, tobacco, or alcohol at any time. 3. Student will stay with the group/chaperone at all times, unless special permission is received. 4. During immersion camp activities there will be appropriate times when students are not in the direct supervision of camp Staff. 5. I understand that all rules, including eligibility criteria, discipline, conduct rules, apply during any student travel sponsored or approved by Chugachmiut. 6. The Participant wishes to be released from liability to any other participants, faculty members or instructors of the immersion camp arising out of acts or events which occur during the course of preparing for or participating in programs and, accordingly, willing to release the other participants, faculty members or instructors of Chugachmiut from such liability. The Participant agrees to release and hold harmless Chugachmiut, its staff, faculty, instructors and students. 7. I (parent or guardian) understand my son/daughter may participate in any tape recording, video recording and photography that may become part of materials or products that could be used by Chugachmiut or shared with other school districts and business partners. 8. I understand that the goal of the is to learn both Sugt stun and to participate in traditional subsistence activities. My student has permission to participate in deep water fishing and hunting activities on a chartered boat operated by a licensed captain, and that during the trip there will be adequate supervision of youth. I give permission I do NOT give permission Medical Permission By signing below, I am giving my permission for my student to obtain medical care in the event that such care is necessary. If possible, the parent(s) or guardian will be contacted in the event of an emergency. Permission is hereby granted to a licensed physician or accredited hospital and their associates to perform any medical and/or surgical procedures that are deemed essential to the treatment of the above named individual. Brief Medical History Allergies: Medication: Diabetes: Medication: Epilepsy: Medication: Other: Medication: Emergency Contact: Phone (home): Phone (work): Emergency Contact (Anchorage, Homer Name: Phone (home): Phone (work): Parent/Guardian Signature: Date: Parent/Guardian Printed Name:

7 Checklist/Packing List Please make sure the forms listed below are signed by your parent/guardian and included in your application package. (Missing forms could delay your acceptance in the program.) Application Form Parent Supplement Form Expectations and Chugach Travel Eligibility Chugachmiut Student & Parent Travel Agreement Forms may be ed or faxed to Chugachmiut Office Fax Packing List Casual Clothes, enough for your fourteen-day stay Jeans/other long pants, t-shirts, long sleeved shirts, sweatshirts Socks, underwear & sleepwear Athletic clothes Gym shoes sweat pants/top Subsistence Gear Boots, raincoat, hat, gloves Overnight Requirements Wash cloth, towel, sleeping bag Swimwear Cold weather gear Coat, hat, gloves & boots Personal Hygiene Items Soap, deodorant, shampoo, toothbrush/paste, comb, etc. One form of picture ID (school ID, Alaska State ID) Spending Money (Please, no more than $50) Your sense of adventure, desire to learn, and to be successful!