Apply Now | International Summer Camp | Summer Camp in VA

APPLICANT INFORMATION

Name

FirstLast

Date of Birth (Age Requirement: 14-18 years old)*

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DD

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Gender*

M
F

Current Grade*

Name of School*

Your Email

Enter EmailConfirm Email

Your Home Address

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

PARENT INFORMATION

MOTHER'S Name*

FirstLast

MOTHER'S Occupation

MOTHER'S Home Phone*

MOTHER'S Cell Phone

MOTHER'S Email*

Enter EmailConfirm Email

FATHER'S Name*

FirstLast

FATHER'S Occupation

FATHER'S Home Phone*

FATHER'S Cell Phone

FATHER'S Email*

Enter EmailConfirm Email

If the parents do not live together, with whom does the Applicant live with?*

Mother
Father

To Whom should we bill Tuition?*

Mother
Father

PROGRAM CHOICES

Check the Box of the Program you are Applying for:

Session A: I Speak Change - Jun 28-Jul 9 - $1200
Session B: I Talk Future - Jul 13- Jul 28 - $2000
International: Session B + The USA: Inside Story - Jul 12 -July 31 - $3000

We strongly recommend applications be received by May 30th

How did you hear about us?*

Youth APPLICANT QUESTIONS

Please answer ALL of the questions below. At least 2 paragraphs should be devoted to each question.

1. Why would you like to come to the Global Youth Village and what do you hope to learn?*

2.Please describe an event or experience that created a significant impression on you.*

3. What international experience have you had (e.g., travel, pen pals, international friends)?*

4. Can you describe your idea of an ideal community and what you can do to create it?*

5. Please describe what qualities you feel a good leader should have and why?

6. What kind of activities (sports, clubs, volunteering, leadership, etc) are you involved in? Which do you enjoy the most and why?*

7. What are your personal goals, and how will your participation in Global Youth Village help you in achieving those goals?*

Parent of APPLICANT QUESTIONS

Please answer ALL of the questions below. At least 2 paragraphs should be devoted to each question.

1. What qualities do you admire in your child?*

2. What special interests have you encouraged in your child?*

3. In what ways do you think the Global Youth Village will help him/her?*

4. What aspects of your child’s character would you like to see strengthened?*

5. Are there any impending or recent changes in your family situation? Please specify (e.g., separation, divorce, illness or death or a relative, change of residence, etc.)?*

6. Please advise us of any special considerations necessary for your child, including medical needs. Please describe if they are currently using medications.*

AGREEMENT and SIGNATURES

PARTICIPANT AGREEMENT: I have read the Global Youth Village Website/Brochure, have read all and /or agree to read all other materials sent to me about Global Youth Village and be informed. I understand Global Youth Village’s mission and agree to comply by the GYV guidelines.*

I Agree
I Disagree

• Be open to new ideas and willing to listen • Respect other people’s point of view, cultural differences and music • Participate fully in all activities • Resolve conflict through communication • Engage in non-exclusive, open relationships which avoid cliques and pairs • Accept predominately vegetarian diet free of sugar for a short period of time • Abstain from tobacco, alcohol and illegal drugs

PARTICIPANTS Signature*

I agree to follow the Global Youth Village guidelines

Date

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DD

YYYY

FOR THE PARENT - I understand that:

• Full tuition is due by May 30, 2013. • Tuition covers room, board, program instruction and materials, and accident and sickness insurance. • Tuition must be paid in accordance with the payment schedule indicated above. • A $25 service charge is assessed on all returned checks. • Legacy reserves the right to cancel any one of the program selections if there is insufficient registration. • In the event of withdrawal before May 30, tuition will be refunded less the $100 deposit. After May 30, tuition will only be refunded if Legacy is able to fill my child's space with a qualified applicant. • In the event that the child withdraws after beginning the three-week session, no refund will be made. • In the unlikely event Legacy cancels the program, tuition will be refunded less the $100 deposit.

FOR THE PARENT: I understand the terms of agreement below:*

I agree
I disagree

• Full tuition is due by May 30, 2013. • Tuition covers room, board, program instruction and materials, and accident and sickness insurance. • Tuition must be paid in accordance with the payment schedule indicated above. • A $25 service charge is assessed on all returned checks. • Legacy reserves the right to cancel any one of the program selections if there is insufficient registration. • In the event of withdrawal before May 30, tuition will be refunded less the $100 deposit. After May 30, tuition will only be refunded if Legacy is able to fill my child's space with a qualified applicant. • In the event that the child withdraws after beginning the three-week session, no refund will be made. • In the unlikely event Legacy cancels the program, tuition will be refunded less the $100 deposit.

DISCOUNTS Check all boxes that apply

PLAN R: Refer a child who is accepted to the program and receive $100 discount.
PLAN EARLY WINTER: Pay Tuition in Full by Feb 20, 2013 and receive $100 discount.
ROUND UP Option: Contribute to the Scholarship Fund for families in need. Pay $100 (tax-deductible)

Parent Signature*

FirstLast

Date*

MM

DD

YYYY

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Submit your application for Global Youth Village international summer camp!

Choose one way to apply:

GYV Application

APPLICANT INFORMATION

PARENT INFORMATION

PROGRAM CHOICES

Youth APPLICANT QUESTIONS

Parent of APPLICANT QUESTIONS

AGREEMENT and SIGNATURES