2017 Exchange Program Chaperone Application
Thank you for your interest in the position of Chaperone for the Longmont Sister Cities Association Student Exchange Program. This position is vitally important to the success of the student exchange. Chaperones have the opportunity to work with a small group of the finest youth in the St.Vrain Valley School area. Two delegations of no more than eight students and two chaperones will be selected. One group will travel to our sister city Chino, Japan and the other group to our sister city Ciudad Guzman, Mexico.
Chaperones can expect reimbursement for travel expenses upon completion of the four portions of their commitment: Pre-trip activities, summer exchange, post-trip activities, and final presentation to the board. Details are spelled out in the Chaperone agreement. The exchange program takes place mid July through mid August, and chaperones may be expected to participate in the hosting phase as well as the travel phase. Reimbursement does not cover passport fees, personal spending money, or gifts.
Training sessions and fundraising activities will take place December - July. Chaperones are expected to plan and carry out training sessions and to participate in fundraisers. Parents of Student Ambassadors, with the help of LSCA members, are involved in the planning of fundraisers. During the school year following the exchange, Student Ambassadors are expected to make presentations to classrooms and community organizations. Chaperones will work with the Student Ambassadors to create and coordinate these presentations. Although the Longmont Sister Cities Association members will assist with the student exchange program, the position of Chaperone is very time consuming. It is also very rewarding. The home stay experience in our Sister Cities is a lifelong memory.
Applicant must be a current resident and/or work in the area bound by the St. Vrain Valley School District. The successful candidate must be willing and available to participate in weekly training sessions, fundraisers, meetings and other activities in the Longmont area and avidly promote the Student Exchange Program and the Sister City relationships with Chino and Ciudad Guzman
Those chaperones selected will be expected to join the LSCA ($15 for an youth/ individual, $25 for a family) and begin working with the students immediately.
The Longmont Sister Cities Association Board of Directors, in its sole discretion, reserves the right to revoke the selection of any chaperone for lack of participation,
Religious, political or any other personal beliefs will remain autonomous and not imposed on any members of the group.
Please check boxes to confirm dates.
Application deadline 10/31/16
By checking the yes box I'm confirming that I have read all the pertinant information about chaperone responsibilities.
How did you hear about the exchange program.
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
The time commitment for orientation sessions, trip preparations and post-travel activities is significant. What flexibility do you have in your schedule to accommodate these commitments?
Briefly describe your educational background and occupation.
Why are you interested in being a chaperone?
What background experience do you have that would prepare you to accompany students on an international exchange?
Tell us about your interest in our sister cities, Chino Japan or Ciudad Guzman, Mexico.
What international travel experience do you have?
In what ways would you be willing to share your experience with the community when you return?
Have you ever been convicted of a crime, other than general traffic tickets? If yes, please explain.
What is your work history for the last 10 years? Please include dates, place, description of duties and responsibilities, supervisor name and phone number and reason for leaving.
Are you trained in first aid? CPR? Other? Please explain.
Please give two character references that can describe your interactions with youth 13-17 years of age. Include name and phone number.
I understand that the LSCA Selection Committee will check my references and employers, and may request other pertinent personal information. I understand I will be asked to provide my date of birth, driver's license number and Social Security Number at my interview in order for the Selection Committee to perform a background check. I understand that all information will be kept confidential.
Should be Empty: