UNIV - Application - Youth Service International

Personal information

Name*

First Last

Father's Name

Required if you are under 18 at the time of the trip

Mother's Name

Required if you are under 18 at the time of the trip

Street 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*

Email Address - Parent

Required if you are under 18 at the time of the trip

Date of Birth*

MM

DD

YYYY

City, State, Country of Birth*

This is needed because, when we register our conference with hotels in Rome, Italian law requires that the hotels collect some basic information about conference participants. Specifically, they need each person's name, date of birth, place of birth, and nationality.

Passport Information

Passport Name*

If you already have a passport, enter your name as printed in the passport. If you do not have a passport yet, enter your full name exactly as you will submit it in the passport application.

Visit travel.state.gov for instructions on getting a passport.

Passport Number*

Passport Issuing Country*

Passport Expiration Date*

Make sure that your passport will have six months of validity beyond the date of your return trip. Italy will not permit a traveler to enter the country unless their passport is set to expire at least six months after the final day of travel.

MM

DD

YYYY

Education

School*

Current Year in School*

Field of Study (if in college / known)

Participation in the UNIV Conference

Participation*

Let us know if you are applying simply to attend the UNIV Conference or would like to submit a paper. Be sure to submit your paper by the deadline.

I will just attend the UNIV conference
I will write and present a paper at the conference
I will submit a video at the conference

For those submitting a paper or video to the conference:

Paper (or video) topic

Name of advisor

For papers only

Email of advisor

For papers only

Miscellaneous

Electronic Signature for Photo Release

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.

Diet, Medical

Do you have any special dietary needs or medical conditions that we should be aware of?

Reference*

Who recommended this program to you?

Comments