Employer: Marital Status: 2 nd Legal Guardian Name: Relationship to applicant: Address (if different than the applicant s): Home Phone: Work Phone:
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- José Francisco Méndez Silva
- hace 6 años
- Vistas:
Transcripción
1 Learning AFAR Guardian Supplemental Form We welcome students of all abilities and backgrounds to compete this application. We believe international travel should be accessible to all youth who are curious about discovering our world. For a Spanish version of the Guardian Supplemental Form, please see the last few pages of this packet. TELL US ABOUT YOUR FAMILY: Today s Date: Name of Your Student Applicant: Parent/Guardian Information: Each applicant should understand that it is his/her responsibility to communicate directly with your educator who is leading this program at your school. In addition, we ask that each applicant provide information for the 1 st Legal Guardian whose role it is to offer support to the applicant. The 1 st Legal Guardian will be included on necessary and phone correspondence that includes logistical information (e.g. travel arrangements, health related topics, payment schedule). 1 st Legal Guardian Name: Relationship to applicant: Address (if different than the applicant s): Home Phone: Work Phone Cell Phone: Address: Employer: Marital Status: 2 nd Legal Guardian Name: Relationship to applicant: Address (if different than the applicant s): Home Phone: Work Phone: Cell Phone: Address: Employer: Marital Status/Relationship to 1 st Legal Guardian: *Please note: We do most of our correspondence through . Please print legibly and provide addresses that are checked frequently. Please indicate clearly if you do not have an address and we will make sure to correspond with you via telephone. Income and Education: *Information in this section is mandatory to be eligible for a scholarship.* Are your students eligible to participate in the free or reduced meals program at your school? Yes, eligible for Free lunch Yes, eligible for Reduced lunch No, we are not eligible Annual household income before taxes: $ How many individuals are supported by your household income? If there is additional information that speaks to your financial need, please help us to understand by providing details below. This is a program for students who could not otherwise pay for this travel opportunity. Please be
2 do not be shy in sharing details as they will help the Selection Committee to better understand that your student needs this scholarship. Please feel free to use an additional sheet of paper as needed. PARENT/GUARDIAN COMMITMENT CHECKLIST Parent/Guardian Personal Commitment Checklist: By initialing the statements below, I indicate that I have given serious thought to each item and I hereby make a commitment to adhere to the statement. 1. I understand that a physical is required after being accepted into this program. 2. I understand that the No Barriers program requires a ~6-month commitment from my student. 3. I understand that the No Barriers program includes three phases model that requires commitment both before and after the expedition. 4. I will make sure that my student attends the required preparatory curriculum sessions. 5. I have read the program specific details about where my student is traveling and which dates they will be gone. 6. I understand that though the No Barriers expedition is very safe and has extensive safety and emergency procedures in place, there is always a small chance that my child could get sick or hurt while traveling. 7. I understand that it is my responsibility to review the recommended immunizations (if applicable) and work with the school and our family doctor to ensure that my son/daughter has what he/she needs in terms of immunizations. 8. I understand that I might have to review informational materials that will help prepare my student for travel. 9. I understand that the No Barriers experience is primarily for students. My participation will only support the group in ways that No Barriers identifies as necessary. Parent/Guardian Signature: Date: / / *If you are applying for a scholarship, your application is NOT complete without one of the following: A copy of your most recent 1040 tax form. In absence of a 1040 tax form, please submit a signed letter stating your combined annual household income.
3 Formulario Suplementario de Padres/Tutores para el programa Learning AFAR Damos la bienvenida a los estudiantes de todos los niveles y orígenes para completar esta solicitud. Creemos que los viajes internacionales deben ser accesibles a todos los jóvenes que sienten curiosidad por descubrir nuestro mundo. CUÉNTENOS SOBRE SU FAMILIA: Fecha de Hoy: Nombre de su estudiante solicitante: Información del Padre/Tutor: Cada solicitante debe entender que es su responsabilidad de comunicarse directamente con el educador que dirige este programa en su escuela. Además, pedimos que cada solicitante proporcione información del primer tutor legal cuya función será ofrecer apoyo al solicitante. El primer tutor legal será incluido en el correo electrónico y la necesaria correspondencia telefónica, que incluye información logística (por ejemplo, planes de viaje, los temas relacionados con la salud, el calendario de pagos). Nombre del Primer Tutor Legal: Relación con el solicitante: Domicilio (si es diferente al solicitante): Teléfono de Casa: Teléfono del Trabajo: Celular: Correo Electrónico: Empleador: Estado Civil: Nombre del Segundo Tutor Legal: Relación con el solicitante : Dirección (si es diferente al solicitante): Teléfono de Casa: Teléfono del Trabajo: Celular: Correo Electrónico: Empleador: Estado civil/relación con el primer tutor: *Tenga en cuenta : Nosotros hacemos la mayor parte de la correspondencia por correo electrónico. Por favor escriba legible y proporcione domicilios de correo electrónico que usan con frecuencia. Favor de indicar con claridad si no tiene una domicilio de correo electrónico y nos aseguraremos de que se correspondan con usted por teléfono. Ingresos y Educación: *La información de esta sección es obligatoria para poder obtener una beca.* Son sus estudiantes elegibles para participar en el programa de comida gratuita o a precio reducido en su escuela? Sí, califica para el almuerzo gratuito Sí, elegibles para almuerzo reducido No, no es elegible Ingreso anual antes de impuestos: $ Cuántas personas son apoyadas con su ingreso familiar?
4 Si hay información adicional que habla sobre su necesidad económica, por favor ayúdenos a comprender agregando detalles en la sección debajo. Este es un programa para los estudiantes que de otro modo no podrían pagar por esta oportunidad de viajar. Por favor, no sea tímido en compartir información, ya que ayudará a la Comisión de Selección para comprender mejor porque el estudiante necesita la beca: LISTA DEL COMPROMISO DEL PADRE/TUTOR Lista del Compromiso del Padre/Tutor: Con mis iniciales en las declaraciones y mi firma, yo declaro que he pensado seriamente a cada elemento y hago un compromiso de cumplir con cada declaración. 1. Entiendo que un examen físico es necesario después de ser aceptado en este programa. 2. Entiendo que el programa No Barriers requiere un compromiso de seis meses de mi estudiante. 3. Entiendo que este programa de No Barriers incluye tres fases que requiere compromiso antes y después del programa. 4. Entiendo que mi hijo/a puede tener tareas adicionales en preparación para su expedición. 5. He leído los detalles específicos sobre la destinación de la programa y las fechas mi estudiante está viajando. 6. Entiendo que aunque la expedición No Barriers es muy segura y tiene procedimientos de emergencia y de extensa seguridad en pie, siempre hay una pequeña posibilidad de que mi hijo/a podría enfermarse o herirse durante el viaje. 7. Entiendo que es mi responsabilidad revisar las vacunas recomendadas (si es aplicable) y trabajar con la escuela y nuestro médico particular para que mi hijo/a tenga lo que él/ella necesite en cuanto a las vacunas. 8. Entiendo que voy a tener que revisar los materiales informativos que ayudarán a preparar a mi hijo/a para viajar. 9. Entiendo que la experiencia No Barriers es principalmente para los estudiantes. Mi participación sólo apoyará al grupo de manera que No Barriers identifique que sea necesario. Firma del Padre/Tutor: Fecha: / / *Si usted está solicitando una beca, su solicitud NO está completa sin uno de los siguientes: Una copia de su más reciente forma de impuestos En ausencia de un formulario de impuestos 1040, envíe una carta firmada en la que declara sus ingresos anuales combinados.
5
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