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ALUM LEADER SERVICE YEAR APPLICATION
THIS FORM IS NOT THE FULL APPLICATION
For instructions on how to correctly apply please refer to the Youthlinc Apply Page and complete steps 1 & 2 under "TO APPLY."
http://www.youthlinc.org/alum-leader-service-year-application-instructions-5/
For questions regarding the application email
office@youthlinc.org
or call 801-467-4417.
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* Indicates required question
Applicants may be assigned to any of the following international sites: Cambodia, Fiji, Kenya, Nepal, Peru, Thailand, Vietnam and Jamaica.
We do our best to keep your preference in mind when assigning international sites.
Indicate your first choice of international site:
*
Choose
Cambodia
Fiji
Kenya
Peru
Thailand
Nepal
Jamaica
Vietnam
No Preference
Peru- Southern Utah
Cambodia- Logan
Indicate your second choice of international site:
*
Choose
Cambodia
Fiji
Kenya
Peru
Thailand
Nepal
Jamaica
Vietnam
No Preference
Peru- Southern Utah
Cambodia- Logan
Indicate your third choice of international site:
*
Choose
Cambodia
Fiji
Kenya
Peru
Thailand
Nepal
Jamaica
Vietnam
No Preference
Peru- Southern Utah
Cambodia- Logan
Travel month preference (this may affect international site placement):
*
Choose
June only
July only
June or July
Youthlinc Alum Leaders must have traveled with Youthlinc in the past? Please list the country(s) and year(s) you have traveled with Youthlinc.
*
Your answer
Are you hoping to travel with another Youthlinc applicant? If so, what is the name of the individual? Keep in mind in order to be selected to travel together, BOTH parties must list each other. Please do not list more than 2 people.
Your answer
APPLICANT INFORMATION
Legal last name as it appears (or will appear) on passport:
*
Must be as it appears on your passport. This name will be used to purchase your flight. You will pay airline name change charges if this name is not entered accurately.
Your answer
Legal first name as it appears (or will appear) on passport:
*
Must be as it appears on your passport. This name will be used to purchase your flight. You will pay airline name change charges if this name is not entered accurately.
Your answer
Legal middle name as it appears (or will appear) on passport:
Must be as it appears on your passport. This name will be used to purchase your flight. You will pay airline name change charges if this name is not entered accurately.
Your answer
Cell phone number: (include area code)
*
Your answer
Applicant's email address:
*
No school emails please
Your answer
Street Address:
*
Your answer
City:
*
Your answer
State:
*
Your answer
Zip:
*
Your answer
Gender
*
Male
Female
Birth date:
*
MM
/
DD
/
YYYY
Age at time of trip departure: (make your best assumption - trips leave in June & July)
*
Your answer
T-shirt size (men's sizes):
*
XS
S
M
L
XL
XXL
Country of citizenship:
*
Your answer
Passport number:
*
If you don't have one put NA
Your answer
Passport expiration date:
*
If you don't have one put NA
Your answer
EMERGENCY CONTACT INFORMATION:
for use on international service trip
Beneficiary name (First, Last):
*
For insurance purposes- usually spouse or parent
Your answer
Beneficiary's E-mail address:
*
Your answer
Beneficiary's best phone number:
*
Your answer
Name of emergency contact (First, Last):
*
For use on international trip
Your answer
Emergency contact's relationship to you:
*
Your answer
Emergency contact's best phone number:
*
Your answer
Emergency contact's E-mail address:
*
Your answer
PARENT INFORMATION
Mother's last name:
*
Your answer
Mother's first name:
*
Your answer
Mother's best phone number:
*
Your answer
Mother's street address (if different than applicant's):
Your answer
Mother's city (if different than applicant's):
Your answer
Mother's state (if different than applicant's):
Your answer
Mother's zip code (if different than applicant's):
Your answer
Mother's E-mail address:
*
Your answer
Mother's place of employment:
*
Your answer
Mother Job title/position
*
Your answer
Father's last name:
*
Your answer
Father's first name:
Your answer
Father's best phone number:
Your answer
Father's street address (if different than applicant's):
Your answer
Father's city (if different than applicant's):
Your answer
Father's state (if different than applicant's):
Your answer
Father's zip code (if different than applicant's):
Your answer
Father's E-mail address:
*
Your answer
Father's place of employment:
*
Your answer
Father Job Title/Position
*
Your answer
EDUCATION & EMPLOYMENT INFORMATION
Name of high school or college/university currently enrolled:
*
Your answer
Indicate what year you are in school:
*
High school grade 10
High school grade 11
High school grade 12
College Freshman
College Sophomore
College Junior
College Senior
Other:
College/graduate students indicate if you are involved in any of the following (check all that apply):
LEAP
Nursing
Social Work
OT/PT
Special Ed
Cumulative GPA:
*
Your answer
Have you ever been involved with Interact, Rotaract, RYLA, or Rotary International?
If so, please describe your involvement.
Your answer
List involvement in community service clubs/activities including start and end dates:
*
Your answer
List past/current employment including start and end dates:
*
Your answer
Enter second language(s) and your level of proficiency if applicable:
Your answer
Are you applying for financial aid:
*
Yes
No
By checking the box below, I am opting-in to receiving information regarding the Youthlinc Service Year
*
Opt-In
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