TEAM LEADER APPLICATION Service Year Humanitarians Mentors Returners Parents Destinations Cambodia Fiji Guatemala Jamaica Kenya Mongolia Nepal Peru Thailand Vietnam Timeline Requirements Local Service Team Meetings Forms Trip Cost Information Safety Fundraising International Trip Committees Sustainability U of U Travel Clinic Diverging Itinerary FAQ Register Referral Program Menu Service Year Humanitarians Mentors Returners Parents Destinations Cambodia Fiji Guatemala Jamaica Kenya Mongolia Nepal Peru Thailand Vietnam Timeline Requirements Local Service Team Meetings Forms Trip Cost Information Safety Fundraising International Trip Committees Sustainability U of U Travel Clinic Diverging Itinerary FAQ Register Referral Program Please enable JavaScript in your browser to complete this form.International Preference - Step 1 of 5Indicate your first choice of international site: *CambodiaFijiGuatemalaJamaicaKenyaMongoliaNepalPeruThailandVietnamIndicate your second choice of international site: *CambodiaFijiGuatemalaJamaicaKenyaMongoliaNepalPeruThailandVietnamIndicate your third choice of international site: *CambodiaFijiGuatemalaJamaicaKenyaMongoliaNepalPeruThailandVietnamTravel month placement (this may affect international site placement): *June onlyJuly OnlyJune or JulyAre 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.NextName *FirstMiddleLastAs 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: *EmailConfirm EmailNo school emails please.Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeGender as stated on passport *MaleFemaleBirthdate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age at time of trip departure: *(make your best assumption - trips leave in June & July) *T-shirt size: *XSSMLXLXXLMen's sizesApplicant's Country of Citizenship: *Passport Number: *If you do not have one, put 0.Pasport Expiration DatePreviousNextBeneficiary name: *FirstLastFor insurance purposes - usually spouse or parent. Beneficiary's email address: *EmailConfirm EmailBeneficiary's phone *Name of emergency contact: *FirstLastEmergency contact's relationhsip to you: *Emergency contact's e-mail address: *EmailConfirm EmailEmergency contact's phone number: *PreviousNextJob 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:PreviousNextBy checking the box below, I am opting-in to receiving information regarding the Youthlinc Service Year *Opt InI have read and understand all of Youthlincs Policies and Procedures *I understandPolicies and ProceduresIn 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 agreePolicies and ProceduresI agree to abide by all the requirements and policies set forth in this Service Year registration. *I agreePolicies and ProceduresSignature of Participant *Participant email for application confirmation *DatePreviousMessageSubmit