• Youth Delegate Application Form

    Note to ALL Youth Applicants:  Thank you for your interest in CISV. Please complete the entire application, including the supplements below (if you are applying for Village or Step Up).  If you are applying for Interchange, please complete the Interchange application. The supplements outline additional responsibilities unique to those CISV programs. Village applicants (age 10-11), please complete the Village Supplement below. Step Up applicants (age 14 or 15): please complete the Step Up Supplement below. Please provide each of your references with a copy of the Youth Delegate Reference Form.

  • Youth Applicant Information

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  • References

    Parents, please send this reference form to two (2) non-family related adults who have knows and have worked with your child. The link to the reference form is: https://form.jotform.com/82516611384153

  • Parent/Guardian Information

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  • 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.

  • What are Parents'/Guardians' current volunteer activities?

  • Will you be able and willing to volunteer with CISV if your child is selected?

  • If your child has previously participated in a CISV program, please describe how you have volunteered and supported the chapter in the past 18 months.

  • Child's Medical History

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  • 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

    The child applicant will agree with CISV Jacksonville Chapter and the National and International officers of CISV (1) to participate fully in the Village, Step Up, Youth Meeting, Fortnight, or other CISV program, (2) abide by the guidelines established by CISV International, INFO FILE R-07, in such manner that will enhance participants' life together and foster courtesy and understanding between us all; (3) not bring or use illegal drugs; (4) to participate in all CISV activities (games, culture sharing, crafts, singing, dances, meetings and work­shops, etc.); (5) to participate to the best of their ability; and (6) to represent my CISV Chapter in a manner that is consistent with the values of the participant's home, community and country.

  • Here are key elements of the CISV Child Behaviour Policy: 

    As a child in CISV, I WILL:
    ● Be friendly, polite and helpful toward others.
    ● Respect everyone regardless of things like age, gender, sex, sexual orientation, ability, race, cultural background or religious beliefs.
    ● Respect the boundaries, privacy and property of others.
    ● Keep myself safe.
    ● Challenge and report the bullying or inappropriate behaviour of others.
    ● Contribute to a creating a safe space for everyone
    ● Be a good role model
    ● Openly share my opinions, needs and concerns
    ● Encourage others to share their ideas.
    ● Follow the rules.


    I have the right to
    ● Be and feel safe
    ● Be listened to
    ● Be respected and treated fairly
    ● Be protected from abuse by other member or outside sources
    ● Participate on an equal basis, appropriate to my ability
    ● Be believed.
    ● Ask for and get help

    I WILL NOT:
    ● Pick on or make fun of others
    ● Bully others
    ● Get involved in peer pressure or push others into something they do not want to do.
    ● Be mean
    ● Break the law


    I understand that CISV programmes and activities are not the place for sexual behaviours or relationships.

  • Click to access the CISV R07 Positive Behavior Policy

    Click to access all CISV Safeguarding Policies

  • NATIONAL TRAVEL POLICY

    1) Village, Step Up, and Interchange 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 Seminar Camp and Youth Meeting 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:

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  • Supplement: Village Youth Delegate

    Complete this section only if the youth is applying for the Village program (age 11). Skip this section unless you are applying for the Village. This section should be completed by the youth applicant.

  • My Family and Home

  • My Friends:

  • My Pets

  • My Travels and Adventures

  • Movie and TV Favorites

  • Likes and Dislikes

  • My Wishes

  • My Camp & Travel Experience

  • Village Family Responsibilities (Please read and complete section below)

    •Host meetings in the home in preparation for the Village experience and as a follow-up after the delegation returns. •See that the delegate attends scheduled delegation meetings. •Attend parent meetings and participate in Chapter activities. •Pay all fees designated by the Chapter by the established deadlines. •Complete the delegate’s passport and visa application, if applicable, within two weeks of selection notification. •Submit the required CISV Health and Legal/Insurance forms by the established deadlines and obtain any immunizations deemed necessary by the public health department. •Decide with the leader and other parents the amount of spending money to take to the Village and comply with that decision. •Provide emergency money as determined by the delegation leader and Chapter with the understanding that emergency money not used will be returned to parents. •Cooperate fully with the delegation leader and encourage your child to accept the leader’s authority during the preparation and travel phases and at the Village. •Be informed about the CISV program so that you can provide a positive and supportive atmosphere for your child. •Help your child understand that he/she is representing the Chapter and the United States as a goodwill ambassador. If a child’s behavior is unacceptable at a Village it is the parent’s responsibility to make arrangements to bring the child home. According to National CISV policy, children under 16 may not travel unless accompanied by an adult. •Assist your child in sharing the Village experience at a Chapter meeting and at other non-CISV meetings for publicity purposes if asked. •Participate in evaluations of the Village experience as requested by the Chapter. •Support and participate in Chapter activities throughout the year and keep informed of Junior Branch activities so that the delegate can participate.

  • Family Acknowledgement:  

  • We are aware of CISV’s policy for selection, preparation, training and the responsibilities of Village delegates and their families. We are prepared to let our son/daughter participate in a CISV Village Program and regard him/her both physically and psychologically fit to participate. We are also prepared to support our son/daughter in his/her future involvement in CISV. 

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  • Step Up Youth Delegate Application Supplement

    Please complete this form if the applicant would like to apply for Step Up Camp (for 14 or 15 year olds - see website for birthdates of eligible youth). Skip this section if you are not applying for the Step Up program for 14 or 15 year olds. This section should be completed by the youth applicant.

  • Step Up Family Responsibilities

  • Step Up participants will:
    • Host meetings in the home in preparation for the Step Up experience and as a follow-up after the delegation returns.
    • See that the delegate attends scheduled delegation meetings.
    • Attend parent meetings and participate in Chapter activities.
    • Pay all fees designated by the Chapter by the established deadlines.
    • Complete the delegate’s passport and visa application, if applicable, within two weeks of selection notification.
    • Submit the required CISV Health and Legal Information forms by the established deadlines and obtain any necessary immunizations.
    • Decide with the leader and other parents the amount of spending money to take to the Step Up and comply with that decision.
    • Provide emergency money as determined by the delegation leader and Chapter with the understanding that emergency money not used will be returned to parents.
    • Cooperate fully with the delegation leader and encourage your child to accept the leader’s authority during the preparation and travel phases and at the Step Up.
    • Be informed about the CISV program so that you can provide a positive and supportive atmosphere for your child.
    • Help your child understand that he/she is representing the Chapter and the United States as a goodwill ambassador. If a child’s behavior is unacceptable at a Step Up it is the parents’ responsibility to make arrangements to bring the child home. According to National CISV policy, children under 16 may not travel unless accompanied by an adult.
    • Assist your child in sharing the Step Up experience at the Fall Chapter meeting and at other non-CISV meetings for publicity purposes if asked.
    • Participate in evaluations of the Step Up experience as requested by the Chapter.
    • Support and participate in Chapter activities throughout the year and keep informed of Junior Branch activities so that the delegate can participate.

     

  • Family Acknowledgement

    We are aware of CISV’s policy for selection, preparation, training and the responsibilities of Step Up delegates and their families. We are prepared to let our son/daughter participate in a CISV Step Up Program and regard him/her as both physically and psychologically fit to participate. We are also prepared to support our son/daughter in his/her future involvement in CISV.
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