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MENTOR REGISTRATION
Service Year
Humanitarians
Mentors
Returners
Parents
Destinations
Cambodia
Ecuador
Fiji
India
Kenya
Nepal
Peru
Thailand
Vietnam
Timeline
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Menu
Service Year
Humanitarians
Mentors
Returners
Parents
Destinations
Cambodia
Ecuador
Fiji
India
Kenya
Nepal
Peru
Thailand
Vietnam
Timeline
Requirements
Local Service
Team Meetings
Forms
Trip Cost
Information
Safety
Fundraising
International Trip
Committees
Sustainability
Big Brothers Bis Sisters Utah
U of U Travel Clinic
Diverging Itinerary
FAQ
Referral Program
Register
Please enable JavaScript in your browser to complete this form.
International Preference
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Step
1
of 8
Indicate your first choice of international site:
*
Cambodia
Fiji
Guatemala
Jamaica
Kenya
Nepal
Mongolia
Peru
Thailand
Vietnam
Indicate your second choice of international site:
*
Cambodia
Fiji
Guatemala
Jamaica
Kenya
Mongolia
Nepal
Peru
Thailand
Vietnam
Indicate your third choice of international site:
*
Cambodia
Fiji
Guatemala
Jamaica
Kenya
Mongolia
Nepal
Peru
Thailand
Vietnam
Travel month placement (this may affect international site placement):
*
June only
July Only
June or July
Are you hoping to travel with another Youthlinc applicant? If so, what is the name of the individual? Keep in mind in order to be selected to travel together, BOTH parties must list each other. Please do not list more than 2 people.
Next
Name
*
First
Middle
Last
As it appears (or will appear) on passport. If you do not have a passport at this time, you can still apply and get your passport later. Your name must be entered as it appears on your passport. This name will be used to purchase your flight.
Cell phone number (include area code):
*
Applicants e-mail address:
*
Email
Confirm Email
No school emails please.
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Gender as stated on passport
*
Male
Female
Birthdate
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Age at time of trip departure:
*
(make your best assumption - trips leave in June & July) *
T-shirt size:
*
XS
S
M
L
XL
XXL
Men's sizes
Applicant's Country of Citizenship:
*
Passport Number:
*
If you do not have one, put 0.
Pasport Expiration Date
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Next
Beneficiary name:
*
First
Last
For insurance purposes - usually spouse or parent.
Beneficiary's email address:
*
Email
Confirm Email
Beneficiary's phone
*
Name of emergency contact:
*
First
Last
Emergency contact's relationhsip to you:
*
Emergency contact's e-mail address:
*
Email
Confirm Email
Emergency contact's phone number:
*
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Next
Job Tite
*
Employer
*
Have you ever been involved with Interact, Rotaract, RYLA, or Rotary International?
If yes, please explain.
List involvement in community service clubs/activities including start and end dates
*
List past/current employment including start and end dates:
*
Enter second language(s) and your level of proficiency if applicable:
Are you applying for financial aid?
*
Yes
No
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Next
Do you volunteer currently?
*
Yes
No
No, but I wish I was volunteering
If yes, how often do you volunteer?
*
More than once per month
At least once per month
At least 2-4 times per month
Once per year or less
I do not currently volunteer
If you do not currently volunteer or do not do so often, please tell us why.
For example: not enough time, difficult to find service opportunities, etc.
If you do volunteer currently, please tell us why.
For example: class or club requirement, you enjoy helping others, etc.
Where did you hear about the Youthlinc Service Year? (Check all that apply)
*
Family
Friend
Teacher
Presentation
Instagram
Facebook
Parent heard about Youthlinc on Facebook
Internet search
Other
Youthlinc referral
Did someone currently enrolled or applying to Youthlinc refer you to apply? If yes, please state the name.
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Next
Personal Statement Submission
Text Box Entry
File Upload
Email to office@youthlinc.org
one page (maximum) single spaced, outlining the reasons for you interest in Youthlinc, what you believe you have to offer as a participant, what you expect to learn and experience while serving locally and globally
Personal Statement
Click or drag a file to this area to upload.
Personal Statement
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Next
I understand that I need to attend all team meetings.
*
I understand
Participants are responsible for following through on all Service Year requirements outlined in this document, participant manuals, team leadership emails, and in team meetings. Monthly team meeting attendance is mandatory, prepares participants for international service and leadership. Participants are responsible for committee assignments associated with the international service experience, which may include activities outside of monthly meeting times. It is the responsibility of each participant to contact Team Leaders and Youthlinc staff with questions or concerns.
I understand that there is a $500 deposit due on December 1st to hold my spot on the team.
*
I understand
By December 1, a $500 non-refundable and non-transferable deposit is due from each participant. This deposit holds your spot on that team. Participants who do not make this deposit will be dropped from the program. An applicant from the waiting list will be invited to participate on the team.
I understand the breakdown of International service experience costs.
*
I understand
At General Orientation for the Service Year, our International Service Director will distribute costs and payment schedules for each international service trip. These costs are inclusive of flights, all in-country transport, accommodations, food, water, major medical and travel insurance (does not include trip cancellation insurance), and Youthlinc program fees. Youthlinc negotiates the best possible airfare for the group, determined as early as possible in the Service Year. Program costs do not include any required travel documentation (e.g. passport, visa) or any recommended vaccinations. Participants are also responsible for their personal expenses in -country, such as toiletries, souvenirs, extra food or beverages other than water. Some students will apply for financial aid support for their international service trip costs. Recipients of financial aid will be notified by or before December.
I understand the Youthlinc Refund Policy
*
I understand
By December 1, a $500 non-refundable and non-transferable deposit is due from each participant. This deposit holds your spot on that team. Participants who do not make this deposit will be dropped from the program. An applicant from the waiting list will be invited to participate on the team. If a participant drops from the program after any deposits, payments, or non-renegotiable contracts are made to coordinators or agencies facilitating our international service experience, including airlines, those deposits or payments are also not refundable. If a participant drops from the program 45 days or less from departure, all payments are non-refundable. Youthlinc reserves the right to cancel or postpone service trips, and change international service sites, at its sole discretion when it deems it necessary or advisable due to local conditions or world events. In the event of any such change, $500 deposits remain non-refundable. Youthlinc may also be required to forfeit nonrefundable payments for airfare and hotel deposits. Any such forfeiture will be charged against participant payments on an equitable basis, as determined by Youthlinc. In such cases, a participant who wishes to serve on an alternate or postponed service trip, or a service trip to an international service site that has been changed, would be required to make up the shortfall. In addition, as described above, amounts transferred to subsequent service trips will be reduced by an allocable portion of any forfeiture of deposits or payments that result from participant or Youthlinc initiated cancellations, postponements, or changes in response to world events or local conditions. Personal donations made which are matched by corporate giving programs are not eligible for refund up to the amount that was matched by the company. No unrestricted or general charitable donations are refundable under any circumstances. Any allowable refund must be requested by participants by June 1. No refunds will be issued until two weeks before departure. Any donations toward a participant’s international experience received after these deadlines will not be refundable, and will be allocated to project funds or sponsorships for the current or following Service Year program. Youthlinc makes every effort to contact participants about their refunds. Any allowable refund that is not collected by a participant after August 31 of any calendar year will be allocated to project funds or sponsorships. After August 31, our Year End, a participant can no longer collect an unclaimed refund.
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Next
By checking the box below, I am opting-in to receiving information regarding the Youthlinc Service Year
*
Opt In
I have read and understand all of Youthlincs Policies and Procedures
*
I understand
Policies and Procedures
In regards to the Summary of Understanding, Assumption of Risk, Waiver of Liability, Indemnification Agreement , Code of Conduct, and Polices for participation in the Youthlinc Service Year, I have carefully read these documents, fully understand and agree to the terms set forth in their content. I am aware that this is a release of liability and a contract between me and Youthlinc. I also acknowledge that this Agreement shall bind my heirs and personal representatives.
*
I agree
Policies and Procedures
I agree to abide by all the requirements and policies set forth in this Service Year registration.
*
I agree
Policies and Procedures
Signature of Participant
*
Participant email for application confirmation
*
Date
Previous
Email
Submit