Philosophy & Ethics Seminar – Application | Youth Service International

Personal Information

Name*

First Last

Father's Name*

Mother's Name*

Address*

City*

State*

Zip*

Home Phone Number*

e.g. 123-456-7890

Cell Phone Number*

e.g. 123-456-7890

Phone Number of Parent (emergency use only)*

e.g. 123-456-7890

Email Address - Student*

Email Address - Parent*

Date of Birth*

Education

School Currently Attending*

Graduation Year from High School*

e.g. 2013

Grade Point Average*

Extracurricular Activities*

Miscellaneous

Electronic Signature for Photo Release (enter YES to accept)

Parents must sign for applicants under 18 years of age.

I hereby authorize and consent to the use and reproduction by YSI staff or an authorized agent or assignee of any and all photographs taken of the above-named applicant for the purpose of promoting YSI programs, without any compensation to me. All film, together with any prints, shall constitute property of YSI, solely and completely.

Reference*

Who recommended this program to you?

Comments

Essay*

Please insert an essay (about 200 words) explaining why you are interested in attending this seminar.

You may want to draft your essay prior to completing the online application and then copy and paste it into the box provided.