Leader/JC Application Form

1. Application portion due by January 10, 2025

Online Leader/JC Application
Leader/JC Confidential Reference Form - 2 references needed*
- School teacher, principal, Director, or Grade Coordinator
- Family friend, coach, or youth leader
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 Leader/JC Confidential Reference Form. Your references will submit the completed online 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.

Junior Counselors (JC's) must be 16-17 years of age for the full length of the program
Leaders must be 21+ for the full length of the program. It is also required for Leaders to have a background check and attend a local and national training prior to travel. Online safeguard training is required as well.
JC's and Leaders are non-paid volunteers

2. Attend Selection Overnight January 17-18, 2025

Leader and JC applicants are required to attend the Selection Overnight January 17-18, 2025. Information about the time and location for the selection overnight will be provided in an email once your application is complete.

Questions? Contact: dfw@cisvusa.org

Thank you for your interest in CISV!

Please remember to provide each of your references with a link to the Leader/JC Confidential Reference Form - https://form.jotform.com/243103166054143

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 (if applicable)

Applicant Current Employment (if applicable)

What is your first language?

What is your educational background? (year of graduation, degrees earned area of study)

Do you speak any other languages? If so, indicate the language(s) and your level of fluency (low, average, high)

In the CISV program, you will need to assist or assume responsibility for some activities such as music, arts and crafts, games, sports, dance, swimming, etc. Please list your interests and skills which could be helpful:

Do you have a certificate in life saving and/or first aid? If so, when does the certification expire?

What is your experience in working with people in a leadership role and as part of a team?

Do you have any experience with CISV or other program involving working with children/youth?

Do you have any experience with CISV or other intercultural organizations or travel programs?

Why do you want to be a JC/Leader for CISV?

Do you take prescription medication? If so, please elaborate below.

List any allergies or dietary restrictions and their effect on your daily activities.

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.

Individual travel (as in the case of Leaders, 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.

In signing this application, we (applicant and parents/guardians) confirm that:

I 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.I release and hold harmless any individual or organization that provides additional information about me to CISV. I 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.I will participate in all CISV Leadership Training Sessions required by CISV. I will abide by and uphold CISV Guidelines on Behavior and Cultural Sensitivity (Info File R-7) and will put the delegates' interest and welfare above my own while attending the program. I understand that before serving in a staff/leadership position, I must be a member of CISV. I have no criminal convictions or history of mental illness, violent behavior, drug abuse, child abuse, or prejudice that would disqualify me from participating in CISV's international, cross-cultural and peace education programs. I agree to a police record check if required by CISV.

Applicant Signature

Applicant Signature Date

Date

If the applicant is under the age of 18, please have a parent/guardian sign this form.

Parent/Guardian Signature

Parent/Guardian Signature Date

Date

CISV DFW Leader/JC Application

Leader/JC Application Form

Short Answer Questions

Medical History

National Code of Conduct Agreement

National Travel Policy

Agreement