SWT APPLICATION

Summer Work Travel Application
Within this online form, you will find the application package for the LifeTraveled Work & Travel Program. You will need your passport to complete the form. You will be asked to upload your proof of enrollment and summer breaks document. Please watch the program overview orientation before completing this application.

Please answer all questions in English.

Thank you.
AGENCY*
EMPLOYER*
IF OTHER, PLEASE WRITE HOST EMPLOYER HERE.

PROGRAM APPLICATION

Please complete this section exactly as the information is on your passport.
APPLICANT FULL NAME (AS PRINTED ON PASSPORT)*

Given Name(s) If you have two given names, write both.Family Name(s) If you have two family names, write both.
PASSPORT NUMBER*
DATE OF BIRTH*

MonthDayYear
WILL YOU BE OVER 18 AND UNDER 28 BY THE START DATE OF YOUR PROGRAM?*
HOW OLD ARE YOU?*
GENDER ON PASSPORT*
GENDER YOU IDENTIFY AS*
YOUR PRONOUNS*
BIRTH CITY*
BIRTH COUNTRY*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
COUNTRY OF LEGAL RESIDENCY*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
COUNTRY ISSUING PASSPORT*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CITIZENSHIP COUNTRY*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

CONTACT INFORMATION
PHONE NUMBER*

Country CodeArea CodePhone Number
EMAIL ADDRESS*
INSTAGRAM HANDLE*
FACEBOOK LINK*
SKYPE ID*
HOME ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
MOTHERFATHERAUNTUNCLESIBLINGGRANDPARENTFRIENDALONE
MARRIAGE STATUS*
DRIVER'S LICENSE NUMBER

PARENT CONTACT INFORMATION
MOTHER'S NAME*

GIVEN NAMEFAMILY NAME
MOTHER'S PHONE NUMBER*

Country CodeArea CodePhone Number
MOTHER'S EMAIL ADDRESS*
example@example.com
FATHER'S NAME*

GIVEN NAMEFAMILY NAME
FATHER'S PHONE NUMBER*

Country CodeArea CodePhone Number
FATHER'S EMAIL ADDRESS*
example@example.com

EMERGENCY CONTACT INFORMATION
WHO IS YOUR EMERGENCY CONTACT?*
EMERGENCY CONTACT NAME*

First NameLast Name
EMERGENCY CONTACT RELATIONSHIP TO YOU*
EMERGENCY CONTACT PHONE NUMBER*

Country CodeArea CodePhone Number
EMERGENCY CONTACT EMAIL ADDRESS*
example@example.com

PREVIOUS VISA INFORMATION

Please provide copies of all vias, visa stamps, or visa denials in your passport.
DO YOU HAVE FAMILY IN THE USA?*
WHERE IS YOUR FAMILY LOCATED?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HAVE YOU BEEN TO THE USA*
WHEN (YEAR) WERE YOU IN THE USA?*
WHAT VISA WERE YOU ON WHILE IN THE USA?*
HAVE YOU BEEN DENIED A USA VISA BEFORE?*
WHEN WERE YOU DENIED A VISA?*
WHAT VISA WERE YOU DENIED?*
HAVE YOU RECEIVED A J1 VISA BEFORE?*
HOW MANY TIMES HAVE YOU PARTICIPATED IN THE J1 PROGRAM?*
WHEN DID YOU RECEIVE YOUR J1 VISA?*
WHO WAS YOUR SPONSOR?*
SOCIAL SECURITY NUMBER (IF ANY)?

CRIMINIAL RECORD SELF-DECLARATION
HAVE YOU EVER BEEN CONVICTED OF A CRIME IN YOUR HOME COUNTRY OR ABROAD?*
PLEASE EXPLAIN*
I acknowledge.

AFFIDAVIT OF SUPPORT

The approximate costs including living expenses are different based on the location that you will be traveling to. Please research the area on-line so that you better understand the costs involved with your location and placement location. You must bring with you a minimum of $1,000 upon arrival to the USA plus any shortage shown on the budget worksheet.

The participant and guarantor must understand that the estimated amount needed for an Exchange Visitor participant to bring with them in order to successfully participate in the Summer Work & Travel Program in the USA is approximately $1000 plus any shortages from the budget worksheet. The guarantor must understand that they will be financially responsible for the Exchange Visitor named above who will be present in the United States for the purpose of attending the Summer Work & Travel Program.
WHO WILL BE THE FINANCIAL GUARANTOR?*
RELATIONSHIP TO PARTICIPANT?*
NAME OF FINANCIAL GUARANTOR*

First NameLast Name
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BUDGET WORKSHEET

As part of your application package, you received a budget worksheet template. This budget worksheet should be completely as realistically as possible, as this is a tool to benefit you and ensure you have realistic ideas of your budgeting on the Work and Travel program.
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I acknowledge that the personal budget indicates the minimum income I should expect to receive as well as the anticipated expenses and taxes that I will be expected to pay. I acknowledge that it is my responsibility to complete the remaining sections of this worksheet to plan for my daily living expenses and determine any additional monies I need to bring with me over the program required $1,000 to compensate for any possible shortage.*

I acknowledge.

PROGRAM INTENTIONS
WHY DO YOU WANT TO PARTICIPATE IN THIS PROGRAM?*

EDUCATIONAL INFORMATION
ACADEMIC INSTITUTION NAME*
ARE YOU A FULL TIME STUDENT?*
HAVE YOU COMPLETED AT LEAST ONE SEMESTER OF FULL TIME STUDY AT THE TIME OF THIS APPLICATION?*
WHAT YEAR OF UNIVERSITY ARE YOU CURRENTLY IN?*
WHEN DID YOU ENTER UNIVERSITY?*

MonthDayYear
Date
WHEN IS YOUR EXPECTED GRADUATION DATE?*

MonthDayYear
Date
AT THE END OF YOUR STUDIES, WHAT WILL YOU RECIEVE?
FIELD OF STUDY *
Per the Department of State program regulations, participants can only participate in the program during the long academic break of their university. As a program participant, you confirm that you understand this. You confirm that you will review your DS-2019 program dates upon receiving the document and confirm that they do not exceed your university's official long academic break period. If the program dates exceed the long academic break or your university break dates change at any point, it is your responsibility to notify LifeTRAVELED immediately. If your DS-2019 program dates exceed your university's official long academic break dates, you will be terminated from the program for non-compliance.*

I acknowledge.
Proof of Enrollment and Summer Breaks Document (School Letter or PEF completed by university)*

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PDF file type only Cancelof
SUMMER VACATION START DATE

MonthDayYear
Date
SUMMER VACATION END DATE

MonthDayYear
Date

PROGRAM REQUIREMENTS

You certify that you are and will

Genuinely interested in learning about the culture of the United States.

Able to arrive to the designated city in the United States and participate in the arrival orientation as determined by LifeTraveled.

Available to work in the US for the entire time of your job agreement.

A current full-time university student in your home country, and have completed at least one semester of a program of post-secondary study and not completed the final year of study. You must demonstrate your intent to return to your course of study following participation in our program. Provide a written letter from your school, on school letterhead and signed in original to certify your status, as well as detailing the exact dates of your summer vacation and enrollment and expected graduation dates.

Able to document proof of sufficient funds in order to support yourself upon arrival in the U.S. (minimum $1000.00) and completed budget worksheet.

Able to prove an intermediate level of English through one or multiple interviews in English.

Aged 18-28 at least one month before your US departure date.

Provide a copy of the 'personal details' page of your passport as well as all the visa stamps from the passport.

Provde a digital photo of your face against a neutral background

Provide the completed Health Questionnaire.

Provide a resume.

Provide a police report, if necessary.

Agree to a background check, if necessary.

Maintain a valid email address throughout the time that the application is active and throughout the program.

Have no criminal convictions.

Read, understand, agree with, and sign the LifeTraveled Terms and Conditions on your own.
SIGN HERE*

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TERMS AND CONDITIONS

Please read this document carefully, and make sure that you understand all the points before you sign. If you have any questions, please e-mail your LifeTraveled representative at SWT@LifeTraveled.org. This is a legal and biding agreement, and it shall constitute part of your agreement with LifeTraveled.

By signing this document, you agree to the following terms and conditions:
You will check-in with LifeTraveled Work & Travel department within three (3) days of arriving in the USA, by calling and speaking with a team member between 9:00 a.m. and 5:00 p.m. Pacific Standard Time, or by logging into the website at www.LifeTraveled.org and providing the check-in information. Failure to do so will result in dismissal from the program, loss of insurance, being reported to the U.S. immigration authorities, and an early return to your home country. Further information on check-in is included in the Work & Travel Participant handbook as well as the Arrival Guide.*

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You will report to the employer confirmed by LifeTraveled by the date designated by your placement. In case you will not be able to report to your employer by the program start date, you must contact LifeTraveled and inform us of the reason for the delay in your arrival as soon as you know you will be arriving late, and no later than two weeks before your scheduled arrival time. LifeTraveled will assess the situation and inform your employer of the circumstances for which you need to change your arrival date. Should the employer not be able to accommodate your late arrival, LifeTraveled will inform you and try to locate other employers for you, provided that the reasons for your late arrival are valid and out of your control. Should an employer not be located in time, you will be canceled from the program and receive a refund based on the LifeTraveled Cancellation Policy.*

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SIGN HERE*

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TERMS AND CONDITIONS
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TERMS AND CONDITIONS - SECOND AND SUBSEQUENT PLACEMENTS

LifeTraveled may grant a request for a change in placement if certain criteria is met. In very specific circumstances only, when the life, welfare or health of a participant is at risk, LifeTraveled may grant a request for a change in placement. It is customary in the US that a 2 week notice is given to the employer to inform them of your intention to leave the placement. Unless an emergency situation warrants for immediate interuption of your job, LifeTraveled requires that at a minimum you comply with this requirement for your request to be considered. You may NOT start working for any other employer than the employer designated on your DS-2019 form, unless you have received express written permission from LifeTraveled that the new employment is authorozied and has been vetted. In order for any new placement to be considered, the Host Employer needs to provide the following documentation for consideration: 1) Copy of valid Workman’s Comp Insurance Policy declaration page.; 2) Copy of Business License OR a copy of each of the following documents as identified below, if a copy of a business license cannot be obtained from the state, county or city where the business operates: a). Articles of Incorporation (required) b) A Certificate of Existence
(required); c) A Certificate of Reinstatement (required, if applicable); d) A screen shot from the Secretary of State’s online database (required if available), indicating the business is in good standing. 3) Job descriptions; 4) Company Grooming standards; 5) Brochures, web-pages, articles, OR Annual Report; 6) Copy of Supervisor’s resume (Training/Internship program only); 7)Signed LifeTraveled Employment Verification Form (please ask the LifeTraveled team to provide you a copy if you do not have one); 7) Signed Host Employer Questionnaire. FAILURE TO COMPLY WITH THIS REQUIREMENT WILL RESULT IN YOUR IMMEDIATE TERMINATION FROM THE PROGRAM, WHICH WILL MEAN THAT YOU HAVE TO RETURN HOME IMMEDIATELY AND IT MAY AFFECT YOUR ABILITY TO TRAVEL TO THE US IN THE FUTURE.
SIGN HERE*

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TERMS AND CONDITIONS
AGENCY*
The Applicant understands that LifeTraveled has contracted with the Partner Agency for the purposes of assisting with J-1 Summer Work Travel application and program administration. The Applicant confirms that he/she has read, agrees with and accepts the fee and refund policy of the Partner Agency. Further, the Applicant has read, agrees with and accepts that LifeTraveled shall provide an appropriate refund only from payments LifeTraveled received for its invoiced service (either from the Applicant or Partner Agency, based on the refund policy listed below). LifeTraveled strongly recommends that the Applicant clearly understands the refund policies of both the Partner Agency and LifeTraveled before signing any participation agreement. The Applicant therefore understands and agrees that he/she shall not hold LifeTraveled responsible for any problems with receiving a refund from the above named Partner Agency or LifeTraveled.
SIGN HERE*

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LifeTraveled has a strict cancellation policy as follows:

CBD = Cancellation before DS-2019 documents have been processed by the sponsor. Full refund less a processing and interview fee of $250 will be processed.

CVD = Cancellation Visa Denied. Participant’s visa was denied. The refund request along with all the supporting documents verifying the denial needs to be submitted to LifeTraveled within 14 days of denial. Paperwork needs to be sent by registered mail. Full refund less $250 processing and interview fee will be processed. If the complete paperwork is not received by the requested time including the original DS-2019 form, LifeTraveled reserves the right to deny a refund.

CUJ = Cancellation unverifiable job. Student provides a job offer that is not verifiable. Partial refund less a processing and interview fee of $250 will be processed.

CMC = Cancellation medical condition. Participant cannot participate in the program due to a medical condition. Supporting documents need to be provided, and refund needs to be requested 6 weeks prior to the original departure date. If refund is requested within the specified time, partial refund less a processing fee of $250 will be refunded. If refund is requested after the specified time, application will be considered CFA.

CFA = Cancellation Full Application. DS-2019 form has been processed. No refund will be approved.

All refunds will be processed within six weeks of receiving the request, based on receiving the refund requests in a timely manner. No refunds will be processed for requests received after the 15th of July. Please check with your local coordinator for any additional fees they may charge.
SIGN HERE*

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PROGRAM OVERVIEW PRESENTATION
I acknowledge.

TERMS AND CONDITIONS

I certify that the information I have given in the application form completed by me is accurate and true. I have read this entire agreement carefully, and I have had the opportunity to ask questions, obtain advice as to its meaning, and I understand it. I am capable of reading and understanding this agreement in English. I do not rely on any promises, statements or representations that are not expressly stated in this Agreement. I agree to abide by the terms and conditions of the LifeTraveled Summer Work & Travel USA Program.
SIGN HERE*

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Summer Work Travel Application