APPLICATION FORM .pdf

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Original filename: APPLICATION FORM.pdf
Author: Vanessa Thomas

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APPLICATION FORM
Instructions: Carefully and legibly complete this form

Applicant Information

First Name

Middle Name

Family Name

Home Address

Male

Age

Date of Birth (Mo/Day/Yr)

Country of Birth

Female

Home Telephone

Mobile Number

E-Mail Address

Family Information
Parent/Guardian

Father Name

Occupation

Name of Company

Home Address

Business Address

Business Numbers

Home Number

E-Mail Address

Parent/Guardian

Mother Name

Occupation

Name of Company

Home Address

Business Address
1

APPLICATION FORM
Business Number

Home Number

E-Mail Address

Parent/Guardian

Guardian Name

Occupation

Name of Company

Home Address

Business Address

Business Number

Home Number

Relationship to Applicant

Education
Present School

School Name

Address

Form Teacher
CXC Qualification (Subjects & Grades )

2

E-Mail Address

APPLICATION FORM
If you have not sat CXC, list subjects

List other Qualification / Certification

Why are you the most suitable candidate for the Youth the Partners of the Americas Youth Ambassadors Program
2012?

3

APPLICATION FORM
What 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

APPLICATION FORM

State how you have or intend to contribute to your community/country?

Are you involved in any school activates?
Yes
No
If yes, please state

Are you involved in your community?
Yes
No
If yes, please state

5

APPLICATION FORM

Are you involved in any religious groups?
Yes
No
If yes, please state

Are you involved in any extracurricular?
Yes
No
If yes, please state

Have you ever travelled to the United States of America?
Yes
No
6

APPLICATION FORM
If yes, please state the last time and the purpose of your visit

Do you have family living in the United States of America?
Yes
No
If 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

APPLICATION FORM
I acknowledge that the information presented above is a true representation of the applicant. I also acknowledge that if
selected further background checks will be done and if any discrepancies this will automatically forfeit my child/ward
ability to participate in the Youth Ambassadors Program.

Parent/ Guardian

Applicant

Date

Date

8


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