Yapsa Student Application 2017
Youth Ambassadors Program with South America
Applicant Information
Name (First name)
Your answer
Surnames (Last names)
Your answer
Sex
DNI
Your answer
Birthday
MM
/
DD
/
YYYY
Age on date of departure (October 15, 2017)
Only people between the ages of 15-17 on date of departure will be considered
Street Address
Your answer
City
Your answer
Province
Your answer
Have you lived anywhere else besides your current city or province? If yes, where?
Your answer
Phone Number
Your answer
Email (This will be used to notify you of acceptance)
Your answer
How did you hear about YAPSA?
Travel Information
Citizenship
Are you currently applying for any additional citizenship or permanent residency?
Please list all countries in which you have or are currently applying for citizenship or permanent residency (if applicable):
Your answer
Have you ever traveled outside of PerĂº?
If you answered "yes" to the previous question please list all countries to which you have traveled (outside of Peru):
Your answer
Do you have a valid Passport?
You must be a Peruvian citizen in order to be eligible for this program. You are not required to have a passport in order to be eligible to apply for this program. However, if accepted you will need to apply for and obtain a passport.
Education and Activities
School Name
Your answer
School Address
Your answer
School Phone Number
Your answer
Is your school a public or private institution?
What grade are you in? (If you are on summer break what grade will you be in when you return to school?)
In what year do you expect to graduate from secondary school?
What academic subjects are you most interested in?
Your answer
Please list any (current or past) extra-curricular activities you are involved in and the years in which you were involved:
Your answer
Please list any certificates/honors/scholarships/awards you have received:
Your answer
Do you have a job? If yes, please describe:
Your answer
Language
English
Please note that you MUST have at least an intermediate speaking level of English to participate in the program. Interviews and program activities will be primarily conducted in English.
Basic
Intermediate
Advanced
Fluent
Speaking
Writing
Reading
Do you speak any other languages? If so, please list below.
Your answer
Family Information
Parent or Guardian 1
Please list the name and contact information of your parent or guardian.
Name
Your answer
Relation
Your answer
Phone
Your answer
Email
Your answer
Parent or Guardian 2
Please list the name and contact information of your parent or guardian, if applicable.
Name
Your answer
Relation
Your answer
Phone
Your answer
Email
Your answer
Are any family members applying to or participating in YAPSA? If yes, list all family members that will or have applied:
Your answer
Essay Questions
Essay Questions need to be written in English!
Short Essay: Why are you interested in participating in this program? What do you hope to learn?
Your answer
Short Essay: Please describe a problem or need in your community. How do you know this is a problem? Why is it important?
Your answer
Long Essay: Please describe an idea you have to create positive change in your community.
Your answer
Long Essay: What makes a good leader? Using two examples, describe how you have shown leadership in your school, community, or home.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Awamaki. Report Abuse - Terms of Service - Additional Terms