Global Youth Leaders Application

Global Youth Leaders Pipeline Program Summer 2022 Opportunities!
We’re Building a New Generation of Global Leaders!

In summer 2022, Aurora Sister Cities International is offering TWO different Global Youth Leaders Pipeline Program summer camps for middle and high school students. Our unique pipeline program builds global skills in youth to better prepare them for a future in the global marketplace!

Camp 1: Global Leadership and Communication
Students, do you want to grow your leadership skills? Do topics like travel, global business, languages, immigration, or international diplomacy interest you? If so, consider joining Aurora Sister Cities International’s Global Youth Leaders Pipeline Program that begins with this summer program. We’ll take you on a fun and exciting journey as you build the skills needed to be a leader in our global and ever-changing world!

When:
- Session 1: June 13-17, 2022 from 9 a.m. to 3:30 p.m.
OR
- Session 2: July 25-29, 2022 from 9 a.m. to 3:30 p.m.
Where: Aurora Municipal Center, 15151 E. Alameda Parkway

Camp 2: Local Leadership in a Global Community
NEW SUMMER 2022 OPPORTUNITY FOR STUDENTS WHO HAVE COMPLETED THE FIRST GLOBAL YOUTH LEADERS PIPELINE PROGRAM SUMMER CAMP!

Join Aurora Sister Cities International for a unique addition to the Global Youth Leaders Pipeline Program. This new summer session, Local Leadership in a Global Community, is designed to engage youth in local government, so they develop leadership, communication, and civic engagement skills to be effective agents of change in our community.

Students, do you like learning about local, national and global issues? Do you see areas in our community and world that you want to change? Do you want to use your voice to create positive change in the world? Then, this summer program is for you!

Like the first summer session that you participated in, this will be a fun and eye-opening week of activities that will engage you and help you grow as a leader. There will also be an opportunity to earn gift cards and future travel opportunities to our sister cities around the world.

When:
- Session 1: July 11-15, 2022 from 9 a.m. to 3:30 p.m.
OR
- Session 2: August 1-5, 2022 from 9 a.m. to 3:30 p.m.
Where: Aurora Municipal Center, 15151 E. Alameda Parkway

PLEASE NOTE: If you are applying for Camp 1 and would also like to apply for Camp 2 this summer, please complete this form for Camp 1 and then contact youthcoordinator@aurorasistercities.net to let them know of your interest in Camp 2.

Which Global Youth Leaders Program Camp do you want to attend?*

Camp 1: Global Leadership & Communication
Camp 2: Local Leadership in a Global Community - for previous summer camp attendees

Please choose one of the two camps above. You will then be able to choose which session you would like to attend. PLEASE NOTE: If you are applying for Camp 1 and would also like to apply for Camp 2 this summer, please complete this form for Camp 1 and then contact youthcoordinator@aurorasistercities.net

Camp 1: Global Leadership and Communication - Choose a Session*

Camp 1 - Session 1: June 13 -17, 2022 from 9 a.m. to 3:30 p.m.
Camp 1 - Session 2: July 25 - 29, 2022 from 9 a.m. to 3:30 p.m.

The program starts with a Global Leadership and Communication summer session. We will meet in person from 9 a.m. to 3:30 p.m. Please ensure you are available from 9am to 5pm Monday through Friday of the week you select. PLEASE NOTE: If you are applying for Camp 1 and would also like to apply for Camp 2 this summer, please complete this form for Camp 1 and then contact youthcoordinator@aurorasistercities.net

Camp 2: Local Leadership in a Global Community - Choose a Session*

Camp 2 - Session 1: July 11-15, 2022 from 9 a.m. to 3:30 p.m.
Camp 2 - Session 2: August 1-5, 2022 from 9 a.m. to 3:30 p.m.

PLEASE NOTE: Only sign up for this camp if you have previously attended the first Global Youth Leaders Pipeline Program.

Participant Information*

First Last

What is the preferred name you like to be called?*

Date of Birth*

Gender Identity (Male/Female/Non-binary/Other)

School Attending Fall 2022*

Grade entering in August 2022?*

Expected High School Graduation Year*

Participants Phone*

Participants Email*

Participants Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please choose the categories that best describe the participant's racial identification. You may choose more than one category.*

White
Black or African American
American Indian or Alaska Native
Asian (not Native Hawaiian or Pacific Islander)
Native Hawaiian or Pacific Islander
Some Other Race not identified in this questionnaire

Does the participant identify their ethnicity as Latino/a, Latinx or Hispanic?

Yes
No

Briefly share why you would like to attend the Global Youth Leaders Pipeline Program Summer Camp 1 on Global Leadership and Communication.*

When did you attend the first ASCI summer camp?*

Briefly share why you would like to attend the Global Youth Leaders Pipeline Program Summer Camp 2 on Local Leadership in a Global Community.*

Parent/Guardian Information

Primary Contact*

First Last

Relationship to child*

Primary Contact Cell Phone

Primary Contact Work Phone

Primary Contact Home Phone

Primary Contact Email

Is Primary Contact's address the same as participants?*

Yes
No

Primary Contact Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact or another Parent/Guardian*

First Last

Relationship to child*

Emergency Cell Phone

Emergency Work Phone

Emergency Home Phone

Emergency Email

Medical Information

Does the participant have any medical conditions that you or your doctor feels could limit program participation?*

Yes
No

If yes, please identify and explain

Is the participant current with Colorado’s vaccine schedule for children attending child care or schools?*

Yes
No

If no, please explain

**A copy of child’s vaccination record must be provided to program administration prior to participation.

Is the participant currently taking any prescription or non-prescription medication?*

Yes
No

If yes, please indicate the medication(s) and the condition(s) being treated

Does the participant have a history of allergies or reactions?*

Yes
No

If yes, please explain

Does the participant have any dietary restrictions (please include religious restrictions in addition to medical restrictions)?*

Yes
No

If yes, please identify and explain

Does the participant have a history of, or currently suffer from any medical condition(s) of which we need to be aware?*

Yes
No

If yes, please explain

Primary Care Physician’s Name or Name of Practice*

Physician’s Phone*

Physician’s Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Does the participant have a Dental Care provider?*

Yes
No

Dentist’s Name or Name of Practice

Dentist’s Phone Number

Healthcare Insurance Information

Does the participant have healthcare insurance?*

Yes
No

If you answered yes above, please fill out the Healthcare Insurance information that will appear below.

Healthcare Insurance Company*

Policy Number*

Policy Holder’s Name (Parent/Guardian)*

Global Youth Leaders Program Release Forms

Please scroll to the bottom of each box and then check the box of consent.

Parent/Guardian Authorization for Healthcare*

This health history is correct and accurately reflects the health status of the participant to whom it
pertains. The person described has permission to participate in all program activities except as noted by
me and/or an examining physician. In emergency situations, I give permission to the physician selected
by Aurora Sister Cities International to order x-rays, routine tests, and treatment related to the health of
my child. If I cannot be reached in an emergency, I give my permission to the physician to hospitalize,
secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the
information on this form will be shared on a “need to know” basis with program staff. I give permission
to photocopy this form. In addition, the program has permission to obtain a copy of my child’s health
record from providers who treat my child and these providers may talk with the program’s staff about
my child’s health status.

I authorize the above

Participant Code of Conduct*

Participation in Aurora Sister Cities International Global Youth Leaders program is subject to the
observance of the program rules. Any participant who knowingly violates this Code of Conduct is subject
to discipline, up to and including removal from the activity. Determination of disciplinary action shall be
done with input from the volunteers and staff overseeing the program or activity. Final decisions about
discipline will be made by the Aurora Sister Cities International staff.
Participants will:
- Show respect for, and cooperate with fellow participants, volunteers and staff.
- Under no circumstances, commit or threaten violence toward any individual, group or the
program.
- Under no circumstances, possess, sell or consume alcohol or possess, sell or use controlled
substances at the Aurora Municipal Center, the Aurora History Museum, the Aurora Welcome
Center or any other facility used for program purposes.
- Under no circumstances, attend or participate in the Global Youth Leaders program under the
influence of alcohol and/or controlled substances including marijuana, tobacco, electronic
cigarettes, etc.
- Under no circumstances, attend the Global Youth Leaders program under the influence of illegal
drugs or other illegal substances.
- Under no circumstances, bring dangerous or unauthorized materials (such as explosives,
weapons or similar items) to the Aurora Municipal Center or other program locations.
Aurora Sister Cities International Global Youth Leaders Program Application and Releases
- Abstain from harassment or bullying of another participant, volunteer or staff member (either in
face to face interactions, through social media or other communication venues), particularly
when the behavior is disrespectful as regarding a person’s gender, race, age, sexual orientation,
religion, national origin, disability, or appearance.
- Not cheat or falsely represent efforts related to Aurora Sister Cities International Global Youth
Leaders program.
I have read and agree to adhere to the above Rules and Code of Conduct of Aurora Sister Cities
International Global Youth Leaders Program. My child and I fully understand the Code of Conduct as
detailed above and I agree to him/her receiving appropriate disciplinary action should he/she breach
them:

I agree

Evaluation Acknowledgement*

As a participant in the Aurora Sister Cities International Global Youth Leaders program, your child may
be asked to help with the evaluation of the program. Your child may be asked to complete a short
survey about what he/she/ they learned or did as a result of the program. Surveys could be given before
the program begins and/or after the program has ended. Surveys typically take no more than 10
minutes to complete. All surveys are confidential. Youth are not required to participate in a survey. If
you or your child does not wish to participate, it will not affect involvement in any programs of Aurora
Sister Cities International.

I agree

Media and Electronic Information Release*

I authorize Aurora Sister Cities International/ Global Youth Leadership Program to record my or my
child’s image and/or voice for use by Aurora Sister Cities International in research, education, and
promotional programs. I understand and agree that these audio, video, film, and/or print images may be
edited, duplicated, distributed, reproduced, broadcasted, and/or reformatted in any form and manner
without payment of fees in perpetuity.
I authorize Aurora Sister Cities International/ Global Youth Leadership Program to send me information, requests and/or notifications through electronic messages which may include email, phone, texting or any other mode of electronic method.

I agree

Parent/Guardian Permission*

I grant permission for my child to participate in Aurora Sister Cities International Global Youth Leaders program.

Permission Granted

Proof of Vaccinations (only required for in-person summer programming)

Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.

Please upload Proof of Vaccinations

Copy of student identification

Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.

School ID OKAY. Other forms of ID could include: Colorado ID card or passport copy

Global Youth Leaders Pipeline Program Summer 2022 Opportunities!
We’re Building a New Generation of Global Leaders!

Parent/Guardian Information

Medical Information

Healthcare Insurance Information

Global Youth Leaders Program Release Forms

About Us

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CONTACT US

About Us

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Aurora’s Sister And Friendship Cities

Global Youth Leaders Pipeline Program Summer 2022 Opportunities! We’re Building a New Generation of Global Leaders!

Parent/Guardian Information

Medical Information

Healthcare Insurance Information

Global Youth Leaders Program Release Forms

Global Youth Leaders Pipeline Program Summer 2022 Opportunities!
We’re Building a New Generation of Global Leaders!