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

Application Deadline: May 10th, 2013

Eligibility for CACTUS’13:

CACTUS’13 welcomes participants from all over Ukraine who:

- Have ideas on how to improve their own communities by implementing community service project;

- Are eager to learn more about youth leadership and community development;

- Are interested in improving their English skills by communicating with native speakers.

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 15 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’13 camp from July 22^nd to August 2^nd 2013.

5) Have attended a Workshop in English Language and Leadership (WELL) Seminar sometime in the spring of 2013.

6) Sign the Code of Conduct if you are 18 (or above), or have it signed by your parents if you are under age, bring it to the camp and oblige to all the rules stated in it.

If you fulfill the aforementioned criteria and are interested in taking part in CACTUS’13, please continue with the application!

Personal Information:

Name:

Date of Birth (Date/Month/Year):

Gender:

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

* If you are a student of the 11^th grade please state the oblast of the university you are going to in order for the CACTUS Team to assign you to one of the regional project groups:

Home Phone Number:

Mobile Phone Number:

Email address:

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

Did you participate in a WELL seminar in 2013? (Please answer yes/no, where, and when):

Were you a participant in CACTUS ’11or ’12? (yes/no; if yes which one?):

If you participated in CACTUS’12 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 or less).

Questionnaire:

1. Why do you want to participate in CACTUS '13? (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’13? What skills will be most useful for you to take away from CACTUS’13, and how will you use them in your community? (200 words or less)

4. What problems do you see in your community? Please specify what changes you would like to see implemented to improve your community?(150 words or less)

5. In your opinion, how popular is volunteerism among young Ukrainians of your age? (100 words or less)

CIT Program:

At CACTUS’13 you may be eligible to participate in the Counselors in Training Program (CIT). This program is for participants who already possess 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 camps. CIT participants study the Advanced Track of Project Development, and they do not attend any Skills Classes. To be a member of the CIT Program, participants MUST:

1. Possess an advanced level of English;

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

3. Have a strong desire to be a staff member at CACTUS ’14;

4. Be 18 years old by the start of CACTUS ’14 (summer 2014).

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

Program at CACTUS ’13, please answer the question below:

1. Why do you want to participate in the CIT Program at CACTUS’13? Why would you make a good staff member at CACTUS’1 3?

2. In your opinion, what would be a perfect social event (a thematic event, organized at CACTUS every evening) for the participants? Please describe it in 200 words or less. Examples: HIV/ AIDS seminar, Fiesta Night.

Class Selection:

During the CACTUS’13 forum you will have a total of 8 workshop days with 4 sessions each day. You will attend workshops on Teamwork and Project Development and will be able to select 2 additional classes, with the sole requirement that one of them comes from the Skills section. If you are accepted to CACTUS ’13, you will have the opportunity to choose these classes before the summer camp begins.

Please note:

Before the CACTUS’13 Camp begins, you will be asked to deposit an extra 100 hryven that you will get back by the end of the camp. If you decide to leave the camp earlier without a legitimate reason, this deposit WILL NOT BE RETURNED. This is done in order to compensate the money that is spent on your accommodation and food in case you leave the Program sooner than in the morning on August 3^rd, 2013.

You will be asked to bring a signed copy of the Code of Conduct that will prove that you agree with all the rules of the Program and oblige to follow them.

I hereby confirm that the information I submitted here is truthful. Moreover I understand that I will pay 600 hrn (400 hrn for Ternopil participants) to help cover the cost of food and accommodation, with an additional deposit of 100 hrn 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: _________________________

1. Please submit your application to [e-mail] with:

· The subject heading of the email “Surname_First Name Participant Application CACTUS_13”

· The Microsoft Word document labeled “Surname_First Name_Participant Application_CACTUS_13”

(Example:Subject: Mariya Dulysh_Participant Application_CACTUS’13)

2. You will receive an email confirming your acceptance by May 31^st, 2013.

We look forwWe look forward to seeing you at the CACTUS’13 Leadership Program!!!

Дата добавления: 2015-10-23