Application form

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Application form

  1. 1. APPLICATION FORM Instructions: Carefully and legibly complete this formApplicant InformationFirst Name Middle Name Family NameHome Address Male Age Date of Birth (Mo/Day/Yr) Country of Birth FemaleHome Telephone Mobile Number E-Mail AddressFamily InformationParent/GuardianFather Name Occupation Name of CompanyHome AddressBusiness AddressBusiness Numbers Home Number E-Mail AddressParent/GuardianMother Name Occupation Name of CompanyHome AddressBusiness Address 1
  2. 2. APPLICATION FORMBusiness Number Home Number E-Mail AddressParent/GuardianGuardian Name Occupation Name of CompanyHome AddressBusiness AddressBusiness Number Home Number E-Mail AddressRelationship to ApplicantEducationPresent SchoolSchool NameAddressForm Teacher CXC Qualification (Subjects & Grades ) 2
  3. 3. APPLICATION FORMIf you have not sat CXC, list subjectsList other Qualification / CertificationWhy are you the most suitable candidate for the Youth the Partners of the Americas Youth Ambassadors Program2012? 3
  4. 4. APPLICATION FORMWhat is your Favourite Quote:What inspires and challenges you daily?What is your proudest moment to date?Please state three changes you would like to see for Youth in Trinidad and Tobago 4
  5. 5. APPLICATION FORMState how you have or intend to contribute to your community/country?Are you involved in any school activates? Yes NoIf yes, please stateAre you involved in your community? Yes NoIf yes, please state 5
  6. 6. APPLICATION FORMAre you involved in any religious groups? Yes NoIf yes, please stateAre you involved in any extracurricular? Yes NoIf yes, please stateHave you ever travelled to the United States of America? Yes No 6
  7. 7. APPLICATION FORMIf yes, please state the last time and the purpose of your visitDo you have family living in the United States of America? Yes NoIf yes, please state relationship and state?Please provide your Reference Contact Details:(Someone who can elaborate on your character eg. a teacher, a pastor, a coach)Name:Address:Relationship to you:Contact Numbers:Email address: 7
  8. 8. APPLICATION FORMI acknowledge that the information presented above is a true representation of the applicant. I also acknowledge that ifselected further background checks will be done and if any discrepancies this will automatically forfeit my child/wardability to participate in the Youth Ambassadors Program. Parent/ Guardian Applicant Date Date 8

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