2. University Information

# ______

Camp “Republic”

July 22^nd – 28^th

Application form

1. Contact Information
Name (first and last):
Date of birth:
Address:
Cell/Home phone #:
E-mail address:
2. University Information
Institute/ University attending:
Specialization:
Year of study:	1^st 2^nd 3^rd 4^th 5^th

3. Rate your level of English ability in

My Self-rating of my ability in

SKILL AREA	Excellent	Good	Fair	Poor
Listening
Speaking
Reading
Writing

4. In order to participate in Camp Republic, you must accept the terms and conditions of the camp. Campers should refrain from any use of drugs or alcohol; any students caught with these substances or under the influence of them will be immediately removed from the camp at their own expense. No campers can visit cabins with campers of the opposite sex after bedtime hours. Absolutely no fighting or use of discriminatory language will be tolerated and will be met with immediate removal from the camp. All campers must 18 years or older by start of camp. Furthermore, Peace Corps is not responsible for any lost items, or personal injury and health issues due to negligence.

By signing, you agree to and understand all terms and conditions of Camp Republic

Signature: _________________________________

5. Upon your acceptance to Camp Republic, you will be required to pay 600 UAH to pay for your one-week stay at the camp. This fee does not include transfer to the city of Kharkov. The payment must be paid by June 1^st or your spot in the camp may be given to someone else.

6. Written Response Question – Your acceptance in this camp will be based upon your ability to sufficiently answer the question in English.

Choose a leader you admire from any period of history. Discuss what characteristics make this person a great leader and why. Provide reasons and examples to support your opinion.

Дата добавления: 2015-11-04