• Student Ambassador Application Form

    Sister Cities of Delray Beach
  • The Sister Cities of Delray Beach student ambassador program is a biennial, 1-week home stay experience in Miyazu, Japan for youth.  It is a 2 year commitment to 9 months of orientation and fundraising in the first, prior to the Japan trip, and to fundraising and a speaking tour in the second. Although all travel expenses are covered by the funds raised by the ambassador families, a nominal monetary contribution is also required. 

  • Directions: Complete all fields of the application form and return all forms together making certain signatures and dates are included.  Upload a photo of yourself to the application. Incomplete applications cannot be processed. Applications are due by Friday, April 11, 2025 no later than 11:59 p.m., and should be submitted to the Jotform.com site. 

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  • Student (Applicant) Details

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  • Parent/Guardian Details

  • Family Situation

  • Student Profile

  • Languages Spoken

  • Student Evaluations

  • Health & Medical

  • STUDENT ESSAY

  • Agreements

  • AGREEMENT. Please read carefully and sign and date where indicated below

     I/We, the undersigned parent/guardians(s) of the applicant and I, the student applicant, agree to the following terms and conditions. This student is applying to participate in a cultural exchange program sponsored by the exchange organization and we give our son/daughter our permission to participate in this program.

    1.      We understand the program is designed to increase understanding among people of the world and it not to be used for the sole purpose of foreign language training. We have discussed the importance of good behavior with our son/daughter and he/ she understands the significance of acting in a manner, which will reflect well on our family and country.

    2.      We understand and agree the enrollment of our son/daughter in the exchange program is primarily for the cultural exchange.

    3.      We understand that the program participant will have responsibilities as a member of the host family including attending religious services although not required; the exchange organization strongly recommends they do as part of family life.

    4.      We agree that the program participant will try to adjust, will obey the disciplinary rules of the host family and school, will give respect and obedience to the host family and school officials, and will keep communication open at all times.

    5.      We understand and agree that the program participant will not take any un-prescribed drugs, drink alcoholic beverages, possess false identification, drive any motorized vehicle, or participate in any dangerous sport such as hang gliding, bungee jumping, etc. If the program participant does any of the above, we understand he/she may be immediately returned home at our family’s expense, and we accept full responsibility for any situation arising his/hers involvement with the above.

    6.      We understand that prolonged or inappropriate use of the internet, including emails or chat rooms may result in a first warning and then result in program termination.

    7.      We understand and agree that the program participant will be subject to all of the laws of the host county. In the case of the serious infraction of the rules and requirements governing the conduct of the program participant, or in the case of extreme home sickness, or poor adjustment to the host family or school, the participant may be returned home immediately at the discretion of the exchange organization’s Executive Community and at the expense of our family.

    8.      We understand that as parents/guardians we are responsible for providing funds to contribute to the expenses of the exchange, an amount to be determined based on airfare rates. We are also responsible for the student’s spending money on the exchange. The suggested amount for spending money is $500.00. In the past, students have chosen to have a uniform to wear while in school in Japan. If the students choose a uniform, parents will also be responsible for that cost.

    9.      We agree that the program participant are not allowed to go home during the program unless under emergency conditions and only with prior approval from the exchange organization’s main office. Visits from the natural parents and friends during the program are strongly discouraged and must have prior written approval. Independent travel is not allowed at any time during the program without written approval for the exchange organization.

    10.  We agree that the program participant is to return home with the rest of the exchange group.

    11.  We agree to pay the early return of our son/daughter if it is deemed necessary for medical reasons after consultation between ourselves, program personnel and the designated medical authorities.

    12.  We agree to pay for any medical and dental bills not covered by the accident and sickness insurance. We agree to pay for the insurance premium and any deductible amount due that the insurance policy might not cover. We also agree to pay the cost for international medical insurance for the trip.

    13.  We agree that the program participant is to possess a passport, and travel visa if necessary. The passport (and visa) is/are to be carried to the foreign country by the participant and is/are to be kept in safe keeping by the participant until time for the participant to return home.

    14.  We agree to pay for any and all telephone calls made by the program participant including those calls made which might appear on the host family’s telephone bill after the departure of the program participant.

    15.  We give the exchange organization the right to use the participant’s name and photograph for reproduction in any medium for the purposes of publication, advertising, trade, display, or editorial use.

    16.  We agree to attend meetings that are schedule to prepare us for the exchange experience.

    17.  We understand and agree to the following:

    ·       Too many absences prior to trip, student will be dropped from group and will not travel on trip.

    ·       Parents fail to participate prior to trip, student will be dropped from the group and will not travel on the trip.

    ·       Student fails to participate after return from trip, student will be dropped from group and parents will be required to reimburse Sister Cities for cost of trip.

    ·       Parents fail to participate after return from trip, student will be dropped from group and parents will be required to reimburse Sister Cities for cost of trip.

     

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  • Required documents

  • Please attach the following documents:

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  • Thank you for completing the online application for the Delray Beach Sister Cities ambassadorship program. A member of our selection committee will reach out to you soon.

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