2021 GYV Virtual Registration

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 INFORMATION
Name
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 Country
Your Email*
Enter Email Confirm Email
Your Cell Phone
PARENT INFORMATION
PARENT/GUARDIAN 1 - Name*
First Last
PARENT/GUARDIAN 1 - Occupation
PARENT/GUARDIAN 1 - Business Phone*
PARENT/GUARDIAN 1 - Cell Phone
PARENT/GUARDIAN 1 - Email*
Enter Email Confirm Email
PARENT/GUARDIAN 2 - Name
First Last
PARENT/ GUARDIAN 2 - Occupation
PARENT/GUARDIAN 2 - Business Phone
PARENT/GUARDIAN 2 - Cell Phone
PARENT/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 Source
PROGRAM CHOICES
Program 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 QUESTIONS
Please 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?**
SIGNATURES
PARTICIPANTS 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: gyv@legacyintl.org or (540) 297-8708

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 INFORMATION

PARENT INFORMATION

PROGRAM CHOICES

Youth APPLICANT QUESTIONS

SIGNATURES

Enrollment and scholarship assistance is on a first come basis. We will notify you via email. Any payments can be made via PayPal.

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