How did you hear about CACTUS (please answer below)?

Application Deadline: May 10th, 2012

Eligibility for CACTUS ’12:

CACTUS ‘12 will welcome participants from all over Ukraine who have an interest in improving their English by communicating with native speakers, learning more about youth leadership and community development, and who have ideas on how to improve their own communities.

To be eligible to apply, you must fulfill the following criteria (NOTE: You may not participate in CACTUS for a third time):

1) Be between 16 and 18 years old

2) Possess an intermediate level of English or higher;

3) Have previous experience in community and youth projects or exhibit a great desire to learn more about projects and implement them in the future;

4) Be able to attend the CACTUS ‘12 forum on July 23^rd to August 3^rd 2012.

If you fulfill the aforementioned criteria and are interested in taking part in CACTUS ‘12, please continue with the application!

Personal Information:

Name:

Date of Birth (Date/Month/Year):

Gender:

Address (street, city/town/village, oblast and postal code):

Home Phone Number:

Mobile Phone Number:

Email address:

Estimated Level of English (low, intermediate, advanced, fluent):

Did you participate in a WELL seminar in 2012? (Please answer yes/no, where, and when):

Were you a participant in CACTUS ’10 or ’11l? (yes/no; if yes which one?):

If you participated in CACTUS’11 were you a CIT? (yes/not):

Do you have or know a Peace Corps Volunteer in or near your town? (yes/no, and who?):

How did you hear about CACTUS (please answer below)?

Previous Experience:

Please list any experience you have with volunteerism; this could include education, work, camps, forums, conferences, community service projects, or any other activity or event related to volunteerism (300 words of less).

Questionnaire:

1. Why do you want to participate in CACTUS '12? (100 words or less)

2. What does "community service" mean to you? (200 words or less)

3. What do you hope to gain by participating in CACTUS '12? What skills will be most useful for you to take away from CACTUS '12, and how will you use them in your community? (200 words or less)

4. What changes would you like to see implemented in your community? (100 words or less)

CIT Program:

At CACTUS ’12 you may be eligible to participate in the Counselors in Training Program (CIT). This program is for participants who already posses experience with community development and demonstrate a strong desire to affect change in their communities and who wish to be staff members in future CACTUS forums. To be a member of the CIT Program, participants MUST be:

1. Possess an advanced level of English;

1. Have previous experience with community leadership and/or community development;

1. Have a strong desire to be a staff member at CACTUS ’13;

1. Be 18 years old by the start of CACTUS ’13 (summer 2013).

If you meet all of the aforementioned requirements and are interested in participating in the CIT

Program at CACTUS ’12, please answer the question below:

Why do you want to participate in the CIT Program at CACTUS ’12? Why would you make a good staff member at CACTUS ’13?

Class Selection:

During the CACTUS ‘12 forum you will have a total of 8 workshop days with 4 sessions each day. You will attend workshops on Team Work and Project Development and will be able to select any 2 others that you prefer, with the sole requirement that one of them comes from the Skills section. If you are accepted to CACTUS ’12 you will have the opportunity to choose these classes before the summer forum begins.

I hereby confirm that I agree to abide to the Code of Conduct and the information I submitted here is truthful. Moreover I understand that I will pay 400 hrn (200 hrn for Ternopil participants) to help cover the cost of food and accommodation, with a deposit of 200 hrn (100 hrn for Ternopil participants) paid in advance prior to arrival (information regarding payment will be sent to you after you’ve been accepted), as well as be responsible for my own travel costs and personal expenses during the program.

Signature: _________________________________ Date: _________________________

***Please email your completed application to cactus.ua@gmail.com with:

• The subject heading of the email “Surname, First Name, Participant Application CACTUS_12”
• The Microsoft Word document labeled “Surname, First Name, Participant Application CACTUS_12”

Date: 2015-12-18; view: 711