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**Partnerships for Learning**

**Youth Exchange & Study Program (YES)**

**Student Application**

**2006-2007 Academic Year**

**STUEDENT NAME (AS IT APPEARS IN PASSPORT):**

**(Last Name) (First Name) (Middle Name)**

**COUNTRY:**

**AYUSA International leads one of several consortia administering the
YES Program on behalf of the U.S. Department of State. The AYUSA
Consortium is comprised of recruitment partners AMIDEAST and iEARN and
U.S. placement partners** **Aspect, ASSE, AYUSA, CIEE, Nacel Open Door,
and PIE.**

**HOW TO APPLY\--STUDENT APPLICATION INSTRUCTIONS**

Together with your parents, complete the entire application and return
it to your in-country representative as soon as possible. Be sure all
information is complete and typed or printed legibly in black ink in
order to be considered for the program.

1\. **FAMILY DATA AND PHOTOGRAPHS**

All questions in this section must be answered. Attach four **smiling**
color photographs with your name written on the back of each to the
first page of the Student Application. The photographs are the first
images the host family and school officials will receive of you.
**Please be sure that you are neatly groomed for the photographs.**

2\. **INTERESTS AND HOBBIES; FUTURE PLANS; PARENTS' CONSENT; PERSONAL
DATA**

These pages will help application reviewers become familiar with your
interests and habits. This information will also help to introduce you
to potential host families, should you be selected for the YES Program.
Please answer all questions honestly and completely.

3\. **SHORT ESSAYS**

This section will provide application reviewers and your potential host
family with a better understanding of who you are and why you want to
come to the United States as an exchange student and participant in the
YES Program. Answer all questions with thoughtful responses using
complete sentences.

4\. **LETTER TO YOUR FUTURE HOST FAMILY**

Spend time seriously thinking about what you want to write in this
important letter to your host family. Practice writing the letter on
another piece of paper first, before typing it on the form. **Do not
include your last name, phone number, home address or email address in
this letter.**

5\. **HOST FAMILY/COMMUNITY PLACEMENT**

This pledge is an important part of you and your parents' understanding
and commitment to this exchange.

6\. **FAMILY ALBUM (optional)**

Your host family in the United States will be curious about you and your
home community. If you would like, select four or more pictures and
write a brief description about each picture, capturing the true spirit
of your daily life. The album will give your host family an
understanding of your family, home, and lifestyle.

7\. **ENGLISH TEACHER\'S RECOMMENDATION**

This important document will help you to gain entrance into an American
high school. Your present English teacher should provide a thorough and
honest assessment of your English capabilities. Any available scores on
a recognized test of English language skills (such as TOEFL) should be
attached. An official school stamp must be included on this page.

8\. **SCHOOL TRANSCRIPT OF GRADES and SCHOOL RECOMMENDATION**

Your AMIDEAST or iEARN representative will help you complete the School
Transcript of Grades form. However, you must submit copies of your last
three years\' official transcripts of school grades in your Student
Application. Include Junior high school transcripts if necessary. When
you come to the United States, bring a copy of your most recent official
transcripts with you so that you can enroll quickly in school. Your
homeroom teacher or school official must complete the School
Recommendation Form.

9\. **STATEMENT OF HEALTH**

Be sure that your parents sign the Medical Release Authorization at the
bottom of this page. Your physician must sign and stamp the Physician's
Statement of Health page.

10\. **IMMUNIZATION RECORD**

[You cannot be admitted to an American high school if this information
is incomplete]{.underline}. If you have not received the immunizations
listed on the form, you will need to be vaccinated before entering the
United States. If serums are not available in your own country, your
parents should provide you with enough extra money to cover the costs of
the vaccinations once you arrive in the United States. U.S. Schools
require that students be immunized before registering for classes.

11. **PARTICIPANT AGREEMENT and GENERAL PROGRAM POLICIES**

> While in the U.S., your program will be conducted under the
> supervision of a partner Placement Organization (PO). PO's for the
> 2006-2007 academic year include ASPECT, ASSE, AYUSA, CIEE, Nacel and
> PIE. A shared participation agreement accompanies this application.
>
> Please familiarize yourself with the rules and policies of the program
> described in this agreement. It is important that you and your natural
> parents fully understand this information and that you and your
> natural parents sign the agreement prior to acceptance on the program.
> These rules have developed based on many years experience of
> conducting successful youth exchange programs and exist to promote a
> successful and enjoyable experience for you and your host family.

### Student Application

  ---------------- --------------------------------------------------------
  **Instructions   All sections of this application must be fully completed
  for completing   in order to be considered for the program; missing
  application:**   information will delay your acceptance. Please type or
                   print using black or blue ink. Do not use pencil. **All
                   pages requiring a signature must be signed.**

  ---------------- --------------------------------------------------------

**Academic Year Program Entry Date:** **2007** **Preferred airport of
departure from** **home country:**

**Student** Name as it appears on your passport:

**Data** Last First Middle

> Full Last Name: Sex: F M Age Upon Arrival:
>
> First and Middle Name: Nickname:
>
> Do you ever spell your name differently? If so, how:
>
> Address: Email:
>
> City: Province: Postal Zone/Code:
>
> Country: Home telephone no: Fax:
>
> Country of Permanent legal residence: Citizenship:
>
> Birth Date: / / City of Birth: Country of Birth:

Day Month Year

Are you a U.S. citizen, permanent resident or green card holder?  Yes 
No

(If yes, you are not eligible to apply for this program)

Have you ever applied to immigrate to the U.S.?  Yes  No

**Father's** Last Name: First name:

**Data:**

> Occupation: Business tel:

**Mother's** Last Name: First Name:

**Data:**

> Occupation: Business tel:

**Family** Student lives with:  Both parents  Mother only  Father
only  Other:

**Data:** Parents are:  Married  Separated  Divorced  Other:

**Family** Name Sex Age Relationship Grade level

**Members**: 1.

> 2\.
>
> 3\.
>
> 4\.

**II. INTERESTS AND HOBBIES**---*To be completed by student*

-   List all school and extracurricular activities and hobbies in which
    you have participated. Start with most recent:

Activity Number of Hours/Week Month/Year Started Month/Year Ended

-   Have you received any awards, or do you have any outstanding
    achievements in the activities listed above?

Name of Award/Achievement Reason for Receiving Award Date Received

-   Are there any activities you would especially like to pursue or
    learn while an exchange student in the U.S.?

-   Community service is an important part of the program. Please
    indicate whether you have participated in community service in your
    country and what community service project(s) you plan to undertake
    in the U.S.

**III. FUTURE PLANS**---*To be completed by student*

-   Do you intend to continue your education upon completion of
    secondary school?  Yes  No

If yes, where?

What do you intend to study?

-   What are your future job or career plans?

**IV. PARENTS\' CONSENT**---*To be completed by parents*

**Son or Daughter Name:**

**My son/daughter has my permission to apply for, and to participate in,
an international study experience sponsored by the YES Program
Consortium.**

**Parent/Guardian's Signature:** **Date:**

**Parent/Guardian's Signature:** **Date:**

**V. PERSONAL DATA**---*To be completed by student*

• Do you any family members or friends in the U.S.?  Yes  No

If yes, please provide the name(s), address(es) and phone number(s).

• Have you ever been the United States?  Yes  No

If yes, when? How long did you stay?

• Have you ever lived or traveled to other countries?  Yes  No

If yes, when and where?

• What are your household responsibilities?

• What time do your parents expect you to be home during the week? on
weekends?

• How much time do you spend studying at home?

• Have you ever lived away from your parents?  Yes  No If yes, please
explain.

• Do you work or have you ever held a job?  Yes  No If yes, please
describe the job(s).

• Religious affiliation/Denomination:

Religious Participation:  Regular  Occasional  Never

How actively would you like to pursue your religion while in the United
States?

 Regularly  Occasionally  Never

• Do you smoke?  Yes  No (It is important to answer this question
honestly.)

> If yes, I understand smoking is illegal in the U.S. for persons under
> 18 years of age and I agree not to smoke on the program.  Yes  No
>
> Student Signature

• Do you have any allergies?  Yes  No If yes, can your allergies be
controlled with medication?

If your allergies cannot be controlled with medication, please contact
AMIDEAST or iEARN for the "Additional Information for Allergic Students"
form.

• Do you follow a special diet (e.g. no pork, vegetarian, low sodium)?

• Have you previously been on a student exchange program?  Yes  No

If yes, please give details, including the country in which you studied.

• Indicate the foreign languages you speak and the number of years
studied:

Language Years of Study

[English]{.underline}

[Other:]{.underline}

**VI. SHORT ESSAYS**---*To be completed by student*

Please answer the following questions on a separate sheet of paper.
There are no "right" or "wrong" answers---only information that helps us
understand you better as an individual.

• Why do you want to be a YES scholar?

• Describe your family, noting its unique or traditional elements and
your relationship with each family member.

• Describe your relationship with a close friend outside of your
immediate family, noting the qualities each of you contributes to the
relationship.

• Describe a non-academic event in which you had to face defeat or
failure, or have made a mistake, and explain how you dealt with it.

• It is natural for exchange students to feel homesick during a year
away from friends, family and school. Reflect for a moment on what it
will be like to live as a member of a family in the United States. What
problems or challenges other than language might you expect to encounter
and how might you deal with them?

**VII. STUDENT\'S LETTER TO FUTURE HOST FAMILY**---*To be completed by
student*

Student's First Name:

Please prepare a letter to your future host family in the space provided
below. The letter must be a full page in length and be printed legibly
and in black ink. Tell why you want to attend high school and live in
the United States with an American family. Write about your skills,
interests, hobbies, expectations, family and friends. Please remember
that this is the first chance your host family will have to get to know
you. **Do not include your last name, home address or email address in
this** letter.

Student Signature: Date:

**VIII. HOST FAMILY/COMMUNITY PLACEMENT**---*To be completed by student*

The program expects you as a student to adjust to the family or
community selected for you. It is important to understand that there is
no \"perfect\" host family and community. You should be prepared to
accept the host family or community the program selects, make every
effort to become a member of the host family and community and
participate successfully in the academic high school program.

**I, the student, and my parents understand and agree to accept the
family or community chosen to host me.**

**Student Signature:** **Date:**

**Parent/Guardian's Signature:** **Date:**

**IX. FAMILY ALBUM (Optional)---***To be completed by student/parents*

On this and the following page you may place photos showing you and your
family and friends in the places you live or frequently visit, doing the
things you usually do or like to do. This is an album for your American
host family so they can better understand the way you live. You may add
additional pages of photos, drawings or descriptions if you like. If you
are not able to complete the family album, please indicate below.

Describe photo #2 below: ⇓

Describe photo #1 above: ⇑

Describe photo #3 above: ⇑

Describe photo #4 above: ⇑

**X. ENGLISH TEACHER\'S RECOMMENDATION**

Student Name:

How long have you known the student? year(s) month(s)

How long have you had the student as an English language student?
year(s) month(s)

Regardless of the student\'s English language proficiency, there will be
periods of difficulty and frustration in speaking English on a daily
basis. Please keep this in mind as you evaluate this student\'s English
language ability. Your evaluation will be used to help determine the
student\'s eligibility for this academic year program. **You must
comment on the student's skills for each section of this evaluation in
order for it to be complete.**

**Reading Comprehension:** Given an American newspaper or magazine
article of at least five paragraphs, the student's English comprehension
is:

 Excellent Understands and explains its meaning clearly and completely.

Understands at least 9 out of every 10 words.

 Good Understands most of its meaning.

Understands 7-8 out of every 10 words.

 Fair Understands the basic vocabulary and explains the basic idea of
the article.

Understands 5-6 out of every 10 words.

 Poor Understands only the simplest words and can explain little, or
none, of the article\'s meaning. Understands 1-4 out of every 10 words.

Please explain your rationale for the above rating:

**Writing:** When asked to write a short essay stating an opinion about
his or her school, town, political view, sports interests, he or she:

 Excellent Writes with near fluency using lengthy sentences, abstract
terms, and strong vocabulary. Uses English grammar rather than composing
the grammar of the native language into English.

 Good Uses good vocabulary. Writes lengthy and sensible sentences.
Sometimes uses irregular grammar, but meaning is clear.

 Fair Makes only simple sentences using limited or basic vocabulary.
Uses extremely irregular grammar, but meaning is clear.

 Poor Writes incomplete, short or basic sentences, using only limited
vocabulary. At times it is difficult to understand what the student
means.

Please explain your rationale for the above rating:

**Speaking and Understanding Conversation:** After engaging the student
in at least 15 minutes of active English conversation, using both
abstract terms and idiomatic phrases, please rate the student\'s ability
to speak and understand English conversation:

 10 Absolute proficiency in English. Student is able to both understand
and converse, using sophisticated vocabulary and clear, correct sentence
structure. Has no trouble with abstract subjects and most idioms. Thinks
in English.

 9 Student is nearly fluent. Uses near-perfect sentence structures. Can
understand and respond to difficult questions. English language
knowledge includes abstract terms. Will have no problems communicating
when he or she arrives in the U.S.

 8 English responses, although not perfect, come naturally. Has a very
good vocabulary and under-stands almost everything. Can respond
intelligently, but needs practice.

 7 Student can understand most conversation. Speaking ability is good,
but needs practice. Student can go beyond basic responses and elaborate
thoughts. Knows many words, but needs to think before responding.

 6 Student understands basic English. Vocabulary includes most common
terms. Thinks quickly; however, it is evident that he or she is
translating. Gets lost when conversation involves abstract terms. Makes
mistakes, but is understandable. Can carry on a basic conversation.

 5 Student can understand much more than he or she can communicate, but
tries. Can respond in sentence form even if grammar and structure are
not perfect. Student is understandable.

 4 Student evidently understands basic English sentences and is able to
respond, even if only in words or phrases. Grammar and sentence
construction is poor, but understandable. (A few weeks of total
immersion in English will improve his or her abilities rapidly.)

 3 Student understands words or phrases, but not complete sentences.
Speaking ability is limited to a few words or phrases.

 2 Student understands a few words, but has little or no ability to
communicate beyond a few words. Student may even refuse to use English.

 1 Student is unable to understand conversation and knows little or no
English.

Please comment on the student\'s motivation and study habits.

Teacher\'s Name (Please Print): Title:

**Official Signature:** Date:

**XI. SCHOOL TRANSCRIPT OF GRADES** ---*To be completed by Overseas
Representative*

## Please attach original transcripts from the student\'s high school for the past three years.

Student's full name:

Birth date: / / Current year of school:

Day Mon Year

School information:

Name Street Address

City Province/ State Country Postal Code

[Type of school:]{.underline}

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<td rowspan="2"><h1 id="name-of-subject">Name of Subject</h1></td>
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To be completed by AMIDEAST or iEARN. Class grade recommendation while
in the U.S.:  10^th^  11^th^

­

Official Signature, Title Date

**XII. SCHOOL RECOMMENDATION**---*To be completed (in English) by school
official or homeroom teacher*

• Has the student missed or repeated a year?  Yes  No

If yes, please explain.

• Does the student have a history of continuous or frequent absences
from school?

 Yes  No If yes, please explain.

• Please comment on the character, motivation, and study habits of the
student.

• Does the student have any special educational needs (i.e. as a result
of dyslexia, word blindness)?

 Yes  No If yes, please explain.

• Has the student had any adjustment or disciplinary problems at school
or in the community?

 Yes  No If yes, please explain.

• Prior to starting the start of the program in the U.S. , how many
years of schooling will the student have completed?

Pre-school Kindergarten Elementary School High school

• Number of instructional days per school year: Hours per day:

Name (Please Print):

Title:

**School Official\'s Signature:** **Date:**

**XIII. STATEMENT OF HEALTH**---*To be completed by parents and
physician*

Student Name: Birthdate: / /

Day Month Year

• Has the student ever had any of the following? If yes, give dates of
illness and detailed information regarding any impairment in the space
provided below.

**[YES]{.underline} [NO]{.underline} [DATE]{.underline}
[YES]{.underline} [NO]{.underline} [DATE]{.underline}**

Chicken Pox   Allergies  

Measles   Asthma  

Mumps   Appendicitis  

Poliomyelitis   Cough (Persistent)  

Rheumatic Fever   Diabetes Mellitus  

Rubella   Enuresis  

Scarlet Fever   Goiter (Struma)  

Malaria   Headache (Persistent)  

Hepatitis   Hernia  

Type Is the student a carrier? Vertigo, Dizziness  

Parasites   Learning Disability  

Seizure Disorder   Anorexia  

Sleepwalking   Bulimia  

• Has the student experienced disease, impairment or abnormality of any
of the following?

Abdominal Organs   Genito-Urinary System  

Bones, Joints   Heart or Blood Vessels  

Blood, Endocrine Sys.   Lungs, Respiratory System  

Brain, Nervous System   Skin (Acne, etc.)  

Ears or Hearing   Tonsils, Nose or Throat  

Eyes or Vision   Varicose Veins  

• Additional Comments, if yes to above:

• Does student have any allergies?  Yes  No If yes, please describe.

• Can allergies be controlled with medication?  Yes  No

• Is student currently using any prescription drugs and/or medication? 
Yes  No If yes, give details and list specific drugs being used.

**MEDICAL RELEASE AUTHORIZATION:**

I hereby authorize the YES Partner Organization, the U.S. host parents
and the local designated Community Representative, without liability or
expense to themselves, to take whatever action they deem appropriate
with regard to my son's or daughter's health and safety. They may place
my son or daughter in a hospital for medical services and treatment or,
if no hospital is readily available, may place them in the hands of a
local medical doctor for treatment. I also authorize any physician to
release any information acquired in the course of examination or
treatment. I certify that the above information is correct to the best
of my knowledge. This authorization shall be valid for the duration of
the program.

**Parent/Guardian Name & Signature:** **Date:**

**Emergency Contact: Phone:** **Fax:** **E mail** :

**XIV. PHYSICIAN\'S STATEMENT OF HEALTH**--- *To be completed by
physician*

• Give your opinion of the general state of the student\'s health.

 Excellent  Good  Fair  Poor

If student\'s health is fair or poor, please explain.

• Are there any restrictions on the student\'s participation in physical
education and/or sports activities?

 Yes  No If yes, please explain.

• Additional comments on the student\'s health.

• Please provide the following information:

Height: ft. in. Weight: lbs. Pupillary and knee reflexes normal?  Yes 
No

Height: cm. Weight: kilos

• **ONLY IF** the student wears glasses or contact lenses, please
complete the following ophthalmic information:

Sphere Cylinder Axis Prism Base

> (OD) Ocular Dexter
>
> (OS) Ocular Sinister
>
> Add: Base Curve:
>
> Other:

• For how long has the student been your patient?

**I, the undersigned, have given a thorough physical examination and
reviewed the medical history of the candidate and certify that all
important medical information has been included and that the above
information is accurate.**

**Physician Name (Please Print) City, Country**

**Work Phone Fax E-mail**

**Physician\'s Signature:** **Date:**

**XV. IMMUNIZATION RECORD**---*To be completed by physician*

Student Name: Birthdate:

Nationality: Gender:

**VACCINE Date Each Dose Was Given:**

**1st** **2nd** **3rd** **4th** **5th** **Country**

Day/Mo/Yr Day/Mo/Yr Day/Mo/Yr Day/Mo/Yr Day/Mo/Yr

**POLIO (TOPV)**

**DTP and/or TD (Diphtheria, Tetanus, Whooping Cough)**

**HEPATITIS B** NA NA

**MEASLES (Rubella 10-day)** If no immunization, give date student had
measles: \_\_\_\_\_\_\_\_\_\_\_

**RUBELLA (German Measles 3-day)** If no immunization, date student had
measles: \_\_\_\_\_\_\_\_\_

**MUMPS** If no immunization, give date student had measles:
\_\_\_\_\_\_\_\_\_\_\_

• **TUBERCULOSIS**: Students to the U.S. must provide proof of
tuberculosis (TB) immunization or testing.

Please check the appropriate box:

This student has been immunized against tuberculosis. TB immunization
date:

If the student has not been immunized, he/she must have a TB Skin Test,
otherwise known as Tine Test.

TB Skin Test Date: Result:  Passed (Negative)  Not Passed (Positive)

• The majority of US high schools require the following immunizations
for school admission:

1\. **POLIO
(TOPV)**\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...........
at least 4 doses

2\. **DIPHTHERIA-TETANUS-PERTUSSIS
(DPT)**\...\...\...\...\...\...\...\...\...\...\........... at least 4
doses

OR,

**DIPHTHERIA-TETANUS (TD
ONLY)**\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
at least 4 doses

3\. **HEPATITIS
B**\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.......\....
3 doses

4\. **MEASLES** (Rubella, 10-day measles)\...\...\...\...\...\...\...one
dose on or after one year of age, or after disease

5\. **RUBELLA** (German measles, 3-day measles)\...\.... one dose on or
after one year of age, or after disease

6\. **MUMPS**
vaccine\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....one
dose on or after one year of age, or after disease

**I, the undersigned, have given a thorough physical examination and
reviewed the medical history of the candidate. I certify that all
important medical information has been included, and that the above
information is complete and accurate.**

**Physician Name (Please Print) Address**

**Physician\'s Signature:** **Date:**

**Partnerships for Learning Youth Exchange and Studey (YES)**:
**Parent-Student Agreement**

Student
Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

ASPECT, ASSE, AYUSA, CIEE, Nacel, PIE and World Heritage are hereafter
referred to as the Placement Organizations or POs.

**Instructions**

You and your parents should carefully review this document and must sign
all three English-language copies. The third copy and the 'home'
language version should be removed from this application and kept by
your parents. Return the two remaining copies as part of your completed
application.

**A. Parents Agreement**

**General Program Policies**

We agree with the statement of purpose of the YES program and have given
our son or daughter permission to participate in this Program. We and
our son or daughter will obey the rules described in the General Program
Policies (please see attached document). We understand the original
English-language version of this document represents the final
authoritative wording of all policies and guidelines.

We affirm that we or any other immediate family member has not applied
to emigrate to the U.S. We understand that if an application for
immigration has been filed, the U.S. Embassy will not issue a visa for
the Program to our son or daughter.

We acknowledge that the Program scholarship does not include payment for
passports for our son or daughter, and that all such expenses, should
there be any, are our responsibility.

We will not visit our son or daughter during his or her participation in
the YES program without obtaining [written]{.underline} approval from
the host family and the Placement Organization. We and our son or
daughter understand that each YES participant must abide by the travel
rules outlined by his or her assigned placement organization.

We understand that if our son or daughter is selected to receive a
scholarship, final acceptance will depend on fulfillment of the medical,
placement and academic requirements of the sponsoring student exchange
organization.

We agree to release and discharge the YES program organization, its
employees, host families, program representatives, and school
representatives from any legal liability, claim or demand in connection
with:

-   any emergency, accident, illness, injury, or other consequences or
    event arising from the actions or participation of our son or
    daughter in the Program, or

-   any cause, event or occurrence beyond the control of the YES program
    organization, including, but not limited to, natural disasters, war,
    civil disturbances, and the negligence of parties not subject to the
    control of the program organization.

**Travel Policies**

We agree that our son or daughter will travel to and from the United
States in strict accordance with the travel plans made by the Program.

We will not encourage or permit our son or daughter to travel outside
the host community during his or her participation in the Program except
in strict accordance with the following requirements:

-   Where our son or daughter desires to travel outside the host
    community with and under the supervision of his or her host
    parent(s), school official or other responsible adult, our son or
    daughter must first obtain approval for such travel from the YES
    Program Organization.

-   Where our son or daughter desires to travel outside the host
    community unaccompanied by his or her host parent(s) school official
    or other responsible adult, our son or daughter must obtain written
    approval for such travel from the YES Program Organization.

We understand that our son or daughter will be responsible for paying
any fees incurred for carrying baggage in excess of the baggage limits
set by the airlines used for Program travel. We understand that this
provision applies to both international travel and domestic travel
within both the U.S. and our home country.

We understand that in making travel arrangements for our son or
daughter, the YES Program Organization contracts with or use commercial
airlines, trains, buses, restaurants, hotels and other entities whose
performance and services cannot be controlled by the Program.
Consequently, we agree that the YES Program Organization is not liable
for any of the actions or negligence of such commercial entities
including, but not limited to, lost baggage, uncomfortable
accommodations, and travel delays. We further agree that the YES Program
Organization reserves the right to change or alter travel, lodging or
other arrangements if they believe that such changes or alterations to
be in the best interest of the participants or the Program.

We understand that our son or daughter must return home at the end of
the program on the date assigned by the responsible YES Program
Organization. Changes to the assigned departure date will not be made to
accommodate graduation, prom, or other special school or family events
that occur after the assigned date. We understand that the U.S. visa
issued to our son or daughter will not be amended or extended beyond the
program end date. No exceptions will be made to this policy.

**School and Host Family Placement**

We authorize the YES Program organization and its employees and
representatives to change the place of residence or school designated
for our son or daughter where they believe such change to be in the best
interest of our son or daughter. We understand that we will be notified
of any such changes.

We recognize that schools in the U.S. may impose academic standards or
other requirements in determining grade level placement that differ from
those imposed in the school our son or daughter now attends. We
acknowledge and accept that participation in the program does not
guarantee credit or graduation from the school our son or daughter now
attends or from the U.S. school he or she will attend while
participating in the program. We understand that it is our
responsibility to arrange with the school our son or daughter now
attends for such credit or graduation upon completion of the Program; or
to arrange for permission for academic absence from any institute or
university to be attended upon return.

We are aware that the U.S. is a multi-racial, multi-ethnic country
providing a diversity of possible living experiences and that there is
no single living experience that is typical. We understand that
placements are made on the basis of criteria designed to determine
suitability of host families and the Program does not discriminate on
the basis of race, religion, or ethnic origin, either of students or of
host families.

**Health/ Medical Issues**

We confirm that the information stated in the Student Health From is
accurate and contains no material omissions of which we are aware. We
affirm that our son or daughter has no chronic physical or emotional
disability that has not been mentioned in this Form or which would make
participation in the Program inadvisable or unreasonably risky. We will
immediately inform the YES program organization of any change in
information given. We understand that such new information may require
reconsideration of our son's or daughter's status in the Program.

We confirm that we have provided a full and complete medical and
immunization history on our son/daughter. We understand that U.S.
schools absolutely require immunizations, and we agree to allow the
Program organization to arrange for all such immunizations, which are
required for our son/daughter.

As the applicant's parents or guardians, we agree to and do hereby,
authorize the YES Program organization, its personnel and
representatives, and the adult members of the host family, to act for us
in any emergency, accident or illness.

**Termination from the Program**

We understand that our son or daughter may be dismissed from the Program
for behavior that the Program, at its discretion, considers detrimental
to our son or daughter or to the Program.

We agree that if we violate any provision of this Agreement, or our son
or daughter, during his or her stay in the U.S :

-   engages in any unauthorized travel;

-   is absent without authorization from the host school or the place of
    residence designated by the YES Program organization; or

-   violates any provision of this Agreement it may be determined that
    our son or daughter has voluntarily withdrawn from the Program.

If our son or daughter voluntarily withdraws, or is dismissed, from the
Program at any time after departure from our country, we understand that
his or her scholarship, visa and health insurance coverage are canceled.
Federal officials may be notified.

**Parent Signature and Date**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**C. Student Agreement** I have read this Agreement and discussed with
my parent(s) its terms and conditions. I agree with the purpose of the
Program and fully accept all terms and conditions of this Agreement, and
all other rules, regulations and conditions set forth concerning the
Program. In particular will do my best to become an integral part of my
host family, school and community; will travel only in accordance with
the rules of this Agreement; and will attend the school designated for
me on a regular basis and complete all work to the best of my ability. I
herby certify that the information provided in all parts of this
application is truthful. I understand that any misrepresentation or
false answer can be grounds for my dismissal from this program.

**Signature of Student and Date**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Signature of Witness and Date**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

I hereby attest that the student and the student's parent(s) or legal
guardian(s) have signed this document before me

**General Program Policies**

**Alcohol:** Students are required to observe all U.S. laws with regard
to the minimum drinking age. Minimum drinking age in the U.S. is 21.
Program dismissal may be considered on the basis of the student's
overall adjustment and an inability to control his/her continued use of
alcohol.

**Drugs:** Program participants may not possess or use drugs which are
illegal in their home country or the U.S. Violators of this policy will
be considered for program dismissal. A verified violation would normally
include physical evidence or student admission or reliable witnesses who
have seen the student in possession of, or using, drugs.

**Employment:** The J-1 visa permitting the student to stay in the U.S.A
restricts employment. Program participants may seek only part-time,
small jobs such as babysitting, yard clean up, etc., according to
specific regulations of Program organization.

**Leaving the Program Early**: If the student is absent from the host
family, school, or other place to which the Program has assigned him or
her, without obtaining the approval of the Program, the Program may
determine that the student has left the Program through his or her own
voluntary action. In this case, the Program is absolved from all
obligation, legal or otherwise, to the student or his/her parents or
guardians for the student's current or future well-being. The Program
will if the circumstances warrant, work with the student to return to
the Program. However, if this cannot be accomplished, a decision will be
made and the separation from the Program is final. Students must leave
the U.S. if this happens

**Marriage:** Married students are not permitted on the Program. If
marriage occurs while the student is a participant or is discovered to
have occurred prior to the student becoming a participant, the student
will be considered for Program dismissal.

**Medical treatment of a student (including emergencies**): Before a
student arrives in the U.S., The Program must receive written permission
from natural parents to obtain emergency medical attention, if needed.
(see Student Health Form). YES Program Organizations, their
representatives and host families are not responsible for any medical
bills, not covered by insurance, incurred by a student regardless of who
signs a hospital admission form. The Program is also not responsible for
nay negative results because of medical treatment.

**Pregnancy:** If a Program participant is found to be pregnant she must
return to her home country. Male students who cause pregnancies also
must return home.

**School attendance**: All Program participants must attend a high
school and maintain a normal course of school work. Non-attendance will
result in consideration for Program dismissal or determining that the
student has left the Program.

**School performance:** Allowing for an initial of linguistic and /or
academic adjustment, a student must achieve and maintain adequate
academic results. After a reasonable period of time, poor motivation,
under-achievement, or inappropriate behavior in combination with poor
family adjustment, may be cause for Program dismissal.

**School expulsion:** If a student is expelled from school, that student
will be considered for Program dismissal.

**Student expenses:** The Program is not responsible for additional
student expenses beyond the incidentals allowance, monthly pocket
allowance, and official Program activities and travel. The host family
is responsible for three meals a day for the student and must provide
either lunch money or a bag lunch if the school does not provide free
lunches for the student and the student cannot go home for lunch. All
other expenses such as extra school fees or activities, social
activities, personal and hygienic supplies, postage and telephone calls,
are paid by the student using Program allowances.

**Student travel:** It is the policy of the Program that only authorized
student travel is permitted. Authorized student travel must generally
meet these three criteria

-   The student's safety is assured to the greatest extent possible

-   The YES program organization has knowledge of the student's location

-   The travel does not interfere with school attendance.

**Unauthorized travel may constitute leaving the Program:** The YES
Program Organization in the U.S. determines authorization for travel.
Procedures for obtaining permission to travel vary by organization.

**Theft/shoplifting:** May constitute cause for Program dismissal. The
nature and severity of the offense will determine procedure and possible
outcome.

**Violation of the law:** When a student admits to a criminal law
violation, is arrested or charged, the student will be considered for
Program dismissal.

**Visits from natural family, home country friends or relatives:**
Natural families, home country friends, or relatives are prohibited from
visiting the exchange student during the Program year. Such visits
interrupt the continuity of the relationship with the host family and
diminish the exchange experience for the student and host family.

**Visits to the home country while on Program:** Visits by students to
the home country while on the Program are not allowed except in the case
of the death or imminent death of an immediate family member. An
unauthorized visit will result in dismissal from the Program. Such trips
break the continuity of the relationship with the host family and may
diminish the exchange experience for the student and host family. Any
request for exceptions must be presented to the YES Program Organization
in the U.S. and approved by the U.S. Department of State.

**Return to home country at the End of the Program:** All students must
return to their home country at the end of program on the date assigned.
Student will not be allowed to remain in the country after their
assigned return travel date.

**Participation on the Program**: No applicant will be considered for a
scholarship to participate on the Program if:

-   Any immediate family member has applied for permission to emigrate
    to the U.S.

-   The applicant does not meet the YES age, grade, class requirements
    for his and her country; and

-   The applicant is not currently a legal citizen of:

  ----- ------------------ --------- ---------- --------- ---------------------
        Gaza               Jordan    Morocco    Qatar     United Arab Emirates

        Iraq               Kuwait    Oman       Syria     West Bank

        Israel (Arab       Lebanon   Pakistan   Tunisia   Yemen
        Communities)                                      
  ----- ------------------ --------- ---------- --------- ---------------------

**Host Family Regulations**: Students must obey host family regulations
regarding curfew, smoking, drinking, dating, or household chores for
which they are responsible. They may not have guests in the Host Family
home without their Host Family's consent and supervision. Students are
responsible to cover the costs of all long distance & international
telephone calls they incur.

**Laws of the Land:** Students are subject to the authority and laws of
their Host Country and must obey all national, state, and local laws and
school regulations. Exchange students enjoy no special immunities from
prosecution. Participants agree to hold YES Program Organizations
blameless for any or all consequences that may result from the Student
breaking the law of the land.

**Life-Changing Decisions**: YES Students may not initiate
"life-changing" decisions while on the Program. This includes changing
religion (though a Student may explore the tenets of any faith),
pregnancy, and marriage. Because of the life-changing impact of these
decisions it is better to wait until the experiences and attachments
coming from an exchange in the Host Country can be viewed from the
perspective of the student's own culture. Students may also be dismissed
from the Program if they develop a life-threatening medical disorder
such as anorexia or bulimia that cannot be adequately treated while on
the Program. Students may not alter their body in any way while on
program. This includes tattoos and body piercings, even if they have
permission from their Parents.

**Legal Proceeding:** Participants consent and authorize YES Program to
pursue or defend any legal proceeding regarding the Student during the
Program, costs to be reimbursed by Parent(s). However, YES Program or
any adult Host Family member is not obligated to pursue or defend any
such legal action or proceedings. The Participants authorize any court,
law enforcement agency, or any other government agency to release the
Student to the YES Program Organization in the event that the Student is
detained or held by any such entity.

**Use of Student's Name and Likeness:** Participants consent and
authorize the YES Program Organizations to use the Student's name,
photograph, file or video likeness of Student or any comments or
statements of Student in materials, publications or on websites to
promote the Program.

**End of Program:** Students to the United States are expected to return
to their home countries within two weeks after their school end date and
no later than June 30 of their program year, pursuant to federal law.
Neither YES Program Organizations staff nor the Host Family will be
responsible for a Student who remains illegally in the U.S. after the
end of the Program. A student who ignores this regulation faces severe
fines and penalties, which may include disbarment from future re-entry
into the United States. In addition, a Student will not be covered by
any insurance policy held by YES Program Organizations after the end of
the Program. Participants expressly release YES Program Organizations,
its representatives, and Host Families from all liability, injury,
damages or claims incurred after termination of the Program.

**Problem Notification and Resolution:** YES Program Organizations
provide ongoing support of all Students; however, Students cannot be
continually supervised or controlled by YES Program organizations. It is
the responsibility of the Student to advise YES Program Organizations of
any significant problems, such as concerns about health, safety,
adjustment problems with school, language or culture or issues involving
the Host Family. YES Program Organizations will make every effort to
intervene and resolve these problems to help the Student successfully
complete the Program. In this effort, YES Program Organizations may, in
its sole discretion, seek a replacement Host Family, if possible within
the same community. However, if the Student does not make a substantial
good faith effort or if the Student violates any terms of this
Agreement, YES Program Organizations may, in its sole and absolute
discretion, terminate the Student's participation in the Program and
immediately repatriate the Student to the home country. Please see
Student Support Issues Policies and Procedures document attached.

**Agreement between Students and Originating Exchange Organization:**
YES Program Organizations has a contractual agreement with its overseas
representatives to operate all programs in full compliance with US
Department of State regulations governing the Exchange Visitors Program
22CFR 62 Part 514 (March 19, 1993) and the standards of the Council on
Standards for International Educational Travel Programs (CSIET). Beyond
the terms of this contract, Participants understand that YES Program
organizations are not a party to any agreement between the Student and
the Originating Student Exchange Organization ("Originating Exchange
Organization") through which they applied for the YES Program in their
home country. Participants acknowledge that all disputes or claims
arising out of any disagreement with the Originating Exchange
Organization shall be resolved directly with the Originating Exchange
Organization.

**General Release and Hold Harmless Provisions:** As a condition of
Student's participation in the Program, the Participants agrees to
release and hold AYUSA harmless for injury, loss, delay, or any damage
and expense incurred by the Student due to: (i) any incident beyond YES
Program organizations' reasonable control, including, without
limitation, acts of God, crimes of violence, acts of war, or government
actions and restrictions; (ii) any events directly or indirectly caused
by intentional or negligent acts or omissions by any third party,
including, but not limited to, any member, guest, employee or agent of
the Host Family or any other persons in the host country; (iii) risks
associated with foreign travel & living abroad, including but not
limited to risks associated with health care, sanitation,
transportation, crime, justice, legal systems, customs, & values; (iv)
any differences in the living conditions & standards between Student's
home & home country, & host home & Host Country; & (v) any act or
omission of the Originating Exchange Organization.

**Indemnification**: As a further condition of Student's participation
in the Program, the Participants agree to indemnify and hold YES Program
Organizations harmless from any liability or expense, including court
costs and attorney's fees, resulting from any injury, loss or any other
damage or expense caused by the Student during his/her participation in
the Program.

**Arbitration and Venue:** This agreement shall be deemed to have been
made in the State of California, USA, and its validity, construction,
breach, performance and interpretation shall be governed by the laws of
the State of California, USA. The parties to the Agreement acknowledge
and agree that any dispute or claim arising out of this Agreement, any
resulting or related transaction, or the relationship of the parties,
shall be decided by neutral, exclusive and binding arbitration in San
Francisco County, California, USA. The arbitration shall be conducted
before JAMS/Endispute, Inc. Either party may appear telephonically at
the arbitration hearing. The award of the arbitrator may be enforced in
any court of competent jurisdiction located in the State of California,
USA. In the event that the arbitration clause is deemed void or
inapplicable, each party expressly consents to and submits to the
personal jurisdiction of the federal or state court (s) of San Francisco
County, California, USA. In any action, including arbitration, brought
for breach of this Agreement, the prevailing party shall be entitled to
recover reasonable attorney's fees and costs, including, but not limited
to, the costs of arbitration.

**Ratification of Contract:** In the event that the Student is under the
age of 18 at the time of execution of this Agreement, and the Student
attains 18 years of age while participating in the Program, the Student
agrees that continued participation in the Program after he/she attains
18 is deemed a ratification and adoption of all the terms and conditions
of this Agreement.

**YES** **Program Agreement Controls:** Where there are any differences
between this Agreement and any other program materials, the Agreement
shall control. YES Program Organizations cannot be legally bound or
committed by any person other than a duly authorized representative.
Parties are required to follow this Agreement and cannot vary from its
terms.

**Modification:** This Agreement shall not be modified except by a
writing that is executed by all parties hereto.

**Severability:** In the event any clause, sentence, term or provision
of this Agreement shall be held by any court of competent jurisdiction
to be illegal, invalid or unenforceable for any reason, the remaining
portions of this Agreement shall remain in full force and effect.