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IOU Respect

International Exchange Application

Summer 2012, Chicago, USA

Egypt, France, Germany, Morocco, Tunisia, United States

(1) Personal InformationFirst and last name:

Date of birth:Preferred mailing address:

Email:

Phone: (Home) (Work) (Cell)

Age:

Sex: 

Occupation :

English is the official language of the IOU Respect program. Please check your ability level.

Ability : beginner  intermediate  advanced  extremely advanced fluent

Are you a vegetarian? Yes No 

Other dietary needs:

Are you allergic to anything? Yes No 

If yes, explain:

(2) Motivation to participate

Answer each of the questions in this section in typed paragraphs. Do not exceed 200 words foreach question. Attach answers to this application.

1. What do you hope to learn through interaction with youth from Egypt, France, Germany,Morocco, Tunisia, and the United States?

2. Describe a class you have taken, a book you have read, or an encounter that you have had that

has inspired you.

3. What experiences have you had interacting with people of ethnic, racial, or socio-economicbackgrounds that differ from your own?

4. To facilitate learning and building bridges between cultures, participants will engage in up to

20 hours (5 sessions) of dialogue sessions throughout the two-week program. Are you willing to

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engage in all of these sessions and listen to the experiences and ideas of other participants as wellas share your personal experiences with others? By checking “Yes” you are committing to

participate in all dialogue sessions: Yes No 

(3) Hostelling ExperiencesHave you ever stayed at a youth hostel before? Yes No 

If yes, describe a positive experience you had while staying at a hostel. If no, describe what you

think you can gain from staying at a hostel versus a hotel.

Do you currently have a Hostelling International membership? Yes No 

(4) Work/Volunteer ExperiencePlease describe any involvement in work activities, volunteer experience, or organizations that

you have been a part of that will help you with skills necessary to communicate effectively with

those of different cultures from your own. Please limit your answer to 200 words. Attach

additional page if necessary.

What are your career goals? 

(5) Interests/SkillsWhat are your favourite leisure time activities?

Do you have any special skills that you might be willing to share during the internationalexchange? Artistic skills? Photography? Musical skills? Writing? Video production? Web site

development? Etc.

(6) EducationLevel of education: currently in college college graduate graduate student

College or University name:Degree earned or current major area of study:

Describe experiences you have had in school or work settings working with groups of people.What insights about yourself or group dynamics did you learn?

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(7) Travel ExperienceWhere have you travelled and for what purpose?

Describe what you think is the most important thing you can learn through travel and how one

might go about learning this.

(8) Additional informationDo you have a valid, current passport? Yes No Any person chosen as a participantfor this program will need to provide a photocopy of his/her passport by June 15, 2012.

Have you ever been convicted of a crime (other than a traffic violation?) Yes No

If yes, please explain.

Please list the two people to whom you have sent reference forms, including their complete

address, phone number, email address, and relationship to you. We ask that at least one referencecome from a current/former supervisor or teacher. Please do not include relatives or friends. We

must receive these references by April 30th

.

Reference #1Name:

Relationship to you:Address:Phone number:

Email address:

Reference #2Name:

Relationship to you:

Address:Phone number:

Email address:

Although this application places no obligation either on you or on Hostelling International, itdoes indicate a serious intention on your part to join the IOU Respect international exchange

program. Should you decide to withdraw your application, please notify us immediately.

Signature   Date