Please complete the registration form below. Space is on a first come, first serve basis up to 100 people and payment is due by May 30, 2021. Virtual Global Youth Village Registration 2021 APPLICANT INFORMATIONName First Last Date of Birth* Month Day Year Gender* Name of Your School* Your Current Grade* Your Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your Email* Enter Email Confirm Email Your Cell PhonePARENT INFORMATIONPARENT/GUARDIAN 1 - Name* First Last PARENT/GUARDIAN 1 - Occupation PARENT/GUARDIAN 1 - Business Phone*PARENT/GUARDIAN 1 - Cell PhonePARENT/GUARDIAN 1 - Email* Enter Email Confirm Email PARENT/GUARDIAN 2 - Name First Last PARENT/ GUARDIAN 2 - Occupation PARENT/GUARDIAN 2 - Business PhonePARENT/GUARDIAN 2 - Cell PhonePARENT/GUARDIAN 2 - Email Enter Email Confirm Email How did you hear about Virtual Global Youth Village?* School Friend Past Participant/Alumni Internet Search Facebook Instagram Youth Dialogue Program - UK Summer Search Please provide name of Individual/Referral SourcePROGRAM CHOICESProgram Dates* July 12 - August 5, 2021 - 3.5 weeks. Approximately 12 hours per week asynchronous (anytime) work and 5-6 hours per week of zoom calls (synchronous) We strongly recommend applications be received by May 30, 2021.Youth APPLICANT QUESTIONSPlease answer ALL of the questions below. At least 2 paragraphs should be devoted to each question.What do you hope to gain by participating in Virtual Global Youth Village?Please describe what qualities you feel a good leader should have and why?What device or devices do you have available in your home to connect with the Global Youth Village virtual exchange program? Smartphone, tablet, desktop, laptop - list all that apply.**Do you have reliable internet at home? If not can you go to a relative or friend's house safely to access the internet?**Does your connection allow you to upload/download the following types of files - jpegs/png, pdfs, mp4, mov files?**SIGNATURESPARTICIPANTS Signature* I agree to follow the Virtual Global Youth Village guidelines and will participate fully in all coursework. Date Year Year Year Tuition is $675 USD Who is paying the tuition?* I would like to learn more about financial assistance yes please FOR THE PARENT - I understand that:* • Full tuition is due by May 30. • Tuition covers all instruction • Tuition must be paid in accordance with the payment schedule indicated above. • Payment can be made via check or Paypal. A $35 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 $50. After May 30, tuition will only be refunded only if Legacy is able to fill my child's space with a qualified applicant. • In the event that the child withdraws after beginning the session, no refund will be made. • In the unlikely event Legacy cancels the program, tuition will be refunded.Parent Signature* First Last Date* Year Year Year Captcha Have questions, contact us: email@example.com or (540) 297-8708 Enrollment and scholarship assistance is on a first come basis. We will notify you via email. Any payments can be made via PayPal.