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YEA School to School Application

Please fill in the information below. * required fields
SCHOOL/GROUP DETAILS:
Name of School/Group: *
Address Line 1: *
Address Line 2:
City: *
State: *	Select... AA AE AK AL AP AR AS AZ CA CO CT DE DC FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NY NV OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY
Postal Code: *
School/Group Website Address:
APPLICANT/CONTACT DETAILS:
Applicant/Contact Name: *
Email Address: *
You are - please select one: *	Staff     Teacher     Student
If you are a student please enter the name and email address of an adult advisor. Advisor Name: Advisor Email Address:
SCHOOL/GROUP GENERAL INFORMATION:
Age range: *	ex. 13-16
Number of Males: *
Number of Females: *
Demographics: *
Language Abilities: *
Location: *	Rural     Urban
Please answer the following questions with as much detail as possible.
1. What are the areas of geographic interest and why? *
2. What are the goals for participation in this project? *
3. Will the school link be incoprorated into the curriculum or will it be part of an     extracurricular activity? *      Curriculum     Extracurricular
4. How will you spread the information and learning from the link to your     school/wider community? *
5. Do you have access to the internet for web chat and/or video conference technology? *     Web Chat     Video Conferencing     Both     None
6. Please list any activities/ideas that you would like to do with your linking partner? *
7. Are you interested in the following areas: *
Yes    No       Knowledge/understanding of other cultures
Yes    No       Day in the life of youth
Yes    No       Youth Participation
Yes    No       Advocacy
Yes    No       HIV/AIDS
Yes    No       Poverty
Yes    No       Community Development
Yes    No       Multi/Media
Yes    No       Arts
Yes    No       Child Exploitation
Yes    No       Education
Yes    No       Environment
Yes    No       Intercultural Exchange
8. Are you able to dedicate a full year to this project? *        Yes    No
9. What do you see as the benefits to students, the school and wider community     of participating in an international school link? *
10. How do you wish to communicate with your linking partner? *
Yes    No       Postal Mail
Yes   No       E-Mail
Yes   No       Web Chat
Yes   No       Video Conferencing
11. Please list any experience that your school group has with international exchanges? *
Additional comments:
After completing this form please click the submit button. You can also print this page and mail it to: Kate Ezzes, Youth Engagement Manager | Plan USA | 155 Plan Way | Warwick, RI 02886 Once the application has been received you will be contacted by a member of the Youth Engagement team to set up your link. Thank you.