CISV DFW Youth Delegate Application Form

CISV DFW Youth Delegate Application
1. Application portion - Due January 10th
- Youth Delegate Application Form
- Youth Delegate Reference Form (YDRF) - 3 references needed*
  - School teacher
  - School principal, Director, or Grade Coordinator
  - Family friend, coach, or youth leader
- Online Parent Volunteer Commitment Form
- Application Fee $50 payable to CISV DFW PayPal dfw@cisvusa.org
- Photo copy of passport page with photo, name, and passport expiration date sent to dfw@cisvusa.org.
*In order to maintain confidentiality, you will provide your references with the link to the YDRF. Your references will submit the completed form directly to CISV DFW through the online form.

We believe that a more accurate reference can be given from someone who has had an entire year to get to know you since these references are due so early in the current school year. Therefore, we recommend:

• one reference must be that of a school teacher from your child's previous school year.
• the second reference must be that of a school principal, director or grade coordinator from your child's previous school year.
• the third reference we request is that of an adult leader, coach or sponsor of some acivity in which your child is currently, or recently has been, a participant. The activity may be school related, but i does not have to be.

2. Attend Selection Overnight January 17-18, 2025

Youth applicants are required to attend the Selection Overnight January 17-18, 2025. Parent interviews will take place the evening of January 17th, while your child is participating in selection activities. If for some reason your family cannot participate in an interview on Selection night we may set up an interview another time.

3. Volunteer requirements for the program year

CISV DFW is an all-volunteer organization. We expect each of our families participating in traveling programs to volunteer a minimum of 20 hours per participating program year. This is 20 hours in addition to your youth’s traveling program delegation meetings. We define volunteering as helping with our hosting programs and local activities. Part of our application package includes a Parent Commitment Form.

Questions? Contact: dfw@cisvusa.org
Youth Delegate Application Form
Note to ALL Youth Applicants - Thank you for your interest in CISV!

Please remember to provide each of your references with a link to the Youth Delegate Reference Form - https://form.jotform.com/243087813275158
Name

First NameLast Name
What CISV DFW program are you interested in for 2025?
Gender Identity
Date of Birth (month/day/year) - example: 02/06/2008
What Racial identity/ethnicity
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Cell Phone Number
Please enter a valid phone number.
Applicant Current School
What is your first language?
Do you speak any other languages? If so, indicate the language(s) and your level of fluency (low, average, high)
Short Answer Questions
What are your interests and hobbies?
What are your activities outside of school?
How did you learn about CISV?
What is your background with CISV?
Parent(s)/Guardian(s) Information
Parent/Guardian 1 Name (Please list in order of who to contact first)*

First NameLast Name
Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 Occupation
Parent/Guardian 1 Employer
Parent/Guardian 1 Cell Phone Number
Please enter a valid phone number.
Parent/Guardian 1 Email
example@example.com
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 Occupation
Parent/Guardian 2 Employer
Parent/Guardian 2 Cell Phone Number
Please enter a valid phone number.
Parent/Guardian 2 Email
example@example.com
CISV requires that both custodial parents/guardians sign this application form (see last page for signature lines), thus confirming that the applicant has permission from both custodial parents/guardians to travel. If an applicant is selected, all additional required CISV forms can be signed by just one custodial parent/guardian, unless CISV is informed in advance of custody issues that make necessary the signatures of both.
*Check the option that best describes your situation:
Notes
*Documentation of full legal custody must be provided
Parent/Guardian 1 - Short Answer Questions
Why do you want your child to participate in CISV?
What are your current volunteer activities?
Will you be able and willing to volunteer with CISV if your child is selected?
Parent/Guardian 2 - Short Answer Questions
Why do you want your child to participate in CISV?
What are your current volunteer activities?
Will you be able and willing to volunteer with CISV if your child is selected?
Applicant Medical History
Does your child take prescription medication? If so, please elaborate below.
List any allergies or dietary restrictions and their effect on your child's daily activities.
If your child is selected, a physician's declaration of your child's health and fitness for CISV participation will be required.
National Code of Conduct Agreement
I, First Name Last Name , do agree with my local CISV Chapter and the National and International officers of CISV to participate fully in . I will abide by the guidelines established by CISV International, INFO FILE R-7 (9008), in such manner that will enhance our life together and foster courtesy and understanding between us all. I will not bring or use illegal drugs. If I am under the age of 18 and smoke, I will bring a signed letter of consent from my parents or guardians. If I am in a country where there is no legal age for drinking and I am under 21, I will furnish a signed letter of consent from my parents or guardians. In all cases I will observe the wishes of my host family regarding drinking and smoking as a matter of courtesy. I will observe such sexual mores and behaviors that will not embarrass or injure others (such behaviors having been discussed with my parents/guardians). I understand I will be expected to participate in all CISV activities (games, culture sharing, crafts, singing, dances, meetings and workshops, etc.) and I agree to participate to the best of my ability. I further agree to represent my CISV Chapter in a manner that is consistent with the values of my home, community and country.
I understand that if I break my agreement, I may be removed from the program at my own expense.
National Travel Policy
1) Village, Step Up, and Youth Meeting delegations shall travel to and from the site of the approved CISV activity as a group. Travel shall be direct and continuous to and from the CISV activity site. No side trips shall be permitted. No layover in excess of 24 hours shall be permitted unless common carrier schedules require otherwise. Delegation itineraries must be approved by the local Chapter.

2) Penalties - Violations of Section 1 will result in disciplinary action against the Chapter or Steering Committee pursuant to the complaint procedure (83-BOT-2) of CISV, Inc.

3) Individual travel (as in the case of Junior Counselors and Fortnight participants) other than to and from the site of an approved CISV activity shall be deemed non-CISV travel. CISV assumes no responsibility or liability for an individual while on a side trip or layover in excess of 24 hours.
Agreement
In signing this application, we (applicant and parents/guardians) confirm that:

We have read, understand, and agree to abide by the National Code of Conduct Agreement and the CISV USA Travel Policy.The information we have provided in this application may be verified by contacting individuals and agencies other than those listed in this application.We release and hold harmless any individual or organization that provides additional information about us to CISV. We also hold harmless any officers or volunteers of CISV International, CISV USA, or the local Chapter of CISV.All information provided on this application is true and correct.
Applicant Signature

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Applicant Signature Date

MonthDayYear
Date
Parent/Guardian 1 Signature

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Parent/Guardian 1 Signature Date

MonthDayYear
Date
Parent/Guardian 2 Signature

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Parent/Guardian 2 Signature Date

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Date
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CISV DFW Youth Delegate Application

Youth Delegate Application Form

Short Answer Questions

Parent(s)/Guardian(s) Information

Parent/Guardian 1 - Short Answer Questions

Parent/Guardian 2 - Short Answer Questions

Applicant Medical History

National Code of Conduct Agreement

National Travel Policy

Agreement