TEAM LEADER APPLICATION

Service Year
Destinations
Timeline
Requirements
Information
FAQ
Register
Referral Program

Service Year
Destinations
Timeline
Requirements
Information
FAQ
Register
Referral Program

International Preference - Step 1 of 5

Indicate your first choice of international site: *

Indicate your second choice of international site: *

Indicate your third choice of international site: *

Travel month placement (this may affect international site placement): *

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.

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: *

Confirm Email

No school emails please.

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Gender as stated on passport *

Male
Female

Birthdate *//

Age at time of trip departure: *

(make your best assumption - trips leave in June & July) *

T-shirt size: *

Men's sizes

Applicant's Country of Citizenship: *

Passport Number: *

If you do not have one, put 0.

Pasport Expiration Date

Beneficiary name: *

First

Last

For insurance purposes - usually spouse or parent.

Beneficiary's email address: *

Confirm Email

Beneficiary's phone *

Name of emergency contact: *

First

Last

Emergency contact's relationhsip to you: *

Emergency contact's e-mail address: *

Confirm Email

Emergency contact's phone number: *

Job Tite *

Employer *

List involvement in community service clubs/activities including start and end dates *

List your previous involvement with Youthlinc *

Enter second language(s) and your level of proficiency if applicable:

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

Name

TEAM LEADER APPLICATION

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