World Smart 2017 Application and Survey
Welcome to the World Smart Leaders application and pre-departure survey. Please take your time and fill out all of the information requested. All information is kept private and is not sold or distributed to any other party or organization. The application should not take more than hour, but does require a few thoughtful answers.

TIP: Use a Word or Google Docs document to type and save your short answer questions and paste them in the application form when you are ready.

We are glad that you are interested in our program and look forward to reviewing your application!

Name *
First and last name
Your answer
What is your address? *
Your answer
Email *
Your answer
Phone number *
Your answer
How did you find out about World Smart? *
Your answer
What interested you in the World Smart program? *
50-100 Words
Your answer
What do you hope to gain from this experience? *
100-150 Words
Your answer
What is special about you that you can use to help your peers during the World Smart experience? *
100-150 Words
Your answer
Have you traveled out of your state before? *
Have flown before? *
Do you have a passport? *
If yes, when does it expire?
Your answer
Have you been out of the country before? *
What are your extracurricular activities? *
Your answer
In addition to school, are you employed? *
Our pre-departure orientation will meet on Saturdays. Will you need transportation? *
Do you plan to attend college? *
What do you plan to study/become? (It’s ok if you are still undecided.) *
Your answer
What is your highest academic goal? (It's ok if you are still undecided.) *
What languages are spoken in your household? (Check all that apply.) *
Required
Are you currently studying or would you like to study a foreign language? *
If you have, which language(s) have you studied?
If you haven't, which language(s) are you interested in learning?
Are you active on social media? *
What platforms? (Check all that apply.) *
Required
Do you follow the news or current events? If so, how?
What is your t-shirt size? *
Gender *
What is your age? *
What school do you attend? *
Your answer
Classification *
Required
What is your GPA? (4.0 scale)
Your answer
Are there any specific subjects that you are having difficulty with in school? Which one(s)? *
Your answer
Please provide the name, address, and contact information for your parent(s) or guardian. *
Your answer
Do you receive free or reduced price school lunch? *
Is your parent or guardian on any financial assistance such as unemployment benefits or SNAP? *
If so, what are they?
Your answer
What other questions (if any) do you have for our team?
Your answer
We will post pictures and videos of our program and our trip to our social media. Your face may be a part of those materials, but they will be used to promote our program only. Please make sure this is ok with your parent or guardian if you are under 18 years of age. Is this ok? *
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