Registration Form - Summer Program Mindful Global Innovator 2026

Summer Program Registration

The Mindful Global Innovator 2026 program is an exclusive, immersive experience offered jointly by Nha Viet Institute and Vermont State University. Designed for aspiring global change-makers, the program blends mindful leadership, cultural fluency, and applied STEM innovation in an American university setting. Participants can choose a 2-week, 3-week, or 4-week program with optional locations in Boston, Vermont, or New York. Throughout the program, participants will practice mindfulness, engage with U.S. campus life, work on 3D/AI-powered design and innovation projects, and build a global network while honoring their heritage identity. Start your journey today by completing this registration form.
Student Information
Student's Name

First Name Last Name
Birth Date

MonthDayYear
Grade Completed in May 2026
English Proficiency (IELTS Equivalent)
No test score yet? No worries, we’ll provide a test during the application process.
Gender

MaleFemaleOther
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Number
E-mail
example@example.com
Sibling's Name Attending This Summer Program (optional)

First NameLast Name
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
What is the name of the high school your child is attending this year?
Educational Partnership Network
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
E-mail
example@example.com
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the student prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Nha Viet Institute and Vermont State University during the selected program. In exchange for the acceptance of said child’s candidacy by Nha Viet Institute and Vermont State University, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Nha Viet Institute and Vermont State University and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected summer program sessions.
Medical Release and Authorization

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Nha Viet Institute and Vermont State University. and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.
Medical Disclosure

Permission is hereby granted to the program organizers and its affiliates may periodically photograph students participating and working during camp. These photographs may be used in a variety of ways; Public relations and marketing purposes: images printed on brochures, posters, and newsletters, or on the Summer Program Website, Facebook Page, and/or other art, education, or news related publications. No names will be included in any photographs or social media posts.
Registration Fee: $55

This non-refundable fee covers administrative costs associated with registration and the application interview process.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

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Registration form includes registration fee AND program date selection. Students are not enrolled until full payment is received.

Registration details

Summer Program 2026 Registration

$55.00

Date selection

$ Free Program name

Total

$0.00

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Summer Program Registration

Student Information