PRE-APPLICATION FORM 2016-17
Kennedy-Lugar Youth Exchange & Study (K-L YES)
Funded/ sponsored by :

In cooperation with:
Please attach passport-sized photo here

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App. No.:

I.

PERSONAL INFORMATION

Complete name as appears in NSO birth certificate/passport: (Last / First / Middle)

Birthdate: (mm/dd/yy)

Complete home/mailing address: (House No., Street, Barangay, City/Municipality, Province)

Home phone w/ area code, if any:

Region:

Mobile phone/s, if any:

Gender:

□ Male
□ Female
ZIP Code:

Email/s, if any:

Name of Father/Legal Guardian:

Name of Mother/Legal Guardian :

Job/Occupation & Employer Name:

Job/Occupation & Employer Name:

Work or Mobile Phone/s, if any:

Email/s, if any:

Work or Mobile Phone/s, if any:

Email/s, if any:

My Passport No. (if available):

My Passport issue date:

My Passport expiry date:

City/Country issuing passport:

PHILIPPINES
Religion:

□ Christianity
□ Islam
□ Other __________________

Ethnic background, if applicable:

Foods I cannot eat / Allergies:

Native/Foreign languages spoken:

Family/relative who has participated in an YES Program or other AFS exchange program:

No. of My Siblings (brothers/sisters):

□ Yes, I have a relative who has participated in YES Program or AFS exchange program.
□ No, I don’t have a relative who has participated in YES or other AFS exchange program.

IF yes, name of relative:

Relationship:

Program Name/Destination:

Date/Month/Year of Departure:

K-L YES Program: I learned about YES through:

□ YES alumni □ AFS returnee/volunteer □ School □ Friends/relatives □ Internet □ Print (newspaper/brochure/poster) □ Other:__________________
II. SCHOOL INFORMATION
Complete school name:

Complete school mailing address: (House No., Street, Barangay, City/Municipality, Province)

Region:

Zip Code:

Complete name of school principal/administrator:

Telephone/s:

Fax:

Year Level in Academic Year 2015-16:

Email/s:

Mobile Phone/s:

Average grade in Academic Year 2014-15

III. K-L YES PROGRAM SPECIFIC INFORMATION
K-L YES Program Overview:
The Kennedy-Lugar Youth Exchange and Study (YES) Program was established by Congress in October, 2002 in response to the events of
September 11, 2001. The program is funded through the U.S. Department of
State and sponsored by the Bureau of Educational & Cultural Affairs (ECA) to provide scholarships for high school students (15-17 years) from countries with significant Muslim populations to spend up to one academic year in the U.S.

BASIC QUALIFICATIONS:
1. Philippine citizen residing in the Philippines, at time of application, selection and preparation for travel; Birthdate must be between August 2, 1998 and
August 1, 2001
2. Currently enrolled in a public/private high school and is among the top 25% of academic performance in grade level; graduating students are not eligible to apply
3. Demonstrated leadership potential in their schools and/or communities;
4. Strong academic and social skills, openness and flexibility;
5. Good English language skills;
6. No previous significant travel to the U.S. on a U.S. government sponsored program 7. Persons With Disabilities (PWD) and Muslim students are highly encouraged to apply

K-L YES 2016-17 REQUIREMENTS:
1. Pre-Application Form; filled-up and with passport-size ID photo;
2. Photocopy of most recent Form 137 or transcript of records from
Philippine high school;
3. Photocopy of school ID, or valid government ID
4. Signed consent by either parent or legal guardian at the bottom of this form NOTE: Please submit only photocopy of original documents, AFS IPP will not be responsible in sending back original copies

This form is provided free of charge and may be photocopied/ reproduced.
YES alumni/ AFS PHI staff/ volunteers & United States Embassy in Manila DO NOT collect any fees from YES applicants or schools. For inquiries please email: phi.sending@afs.org

ESSAY PART 1
Complete name as appears in NSO birth certificate/passport/school records: (Last / First / Middle)

TOPIC: WHAT ARE THE CHARATERISTICS OF A YOUTH PEACE AMBASSADOR?

Please use/attach extra sheet/page as needed

Program:

YES 2016-17

ESSAY PART 2
Complete name as appears in NSO birth certificate/passport/school records: (Last / First / Middle)

Program:

YES 2016-17
Tell us about yourself: Introduce yourself (i.e., how you see yourself, your personality, your relationship with your family and friends, your responsibilities at home and at your school, list your favorites, interests and hobbies, organization memberships, volunteer initiatives, and indicate how often you pursue them, etc. Please attach a separate sheet as needed.)

Tell us about your expectations (before, during & after) the YES Program:

Tell us about your goals or plans which are important to you; and why you think you should be chosen for the YES Program scholarship: Please use/attach extra sheet/page as needed

CERTIFICATION AND CONSENT
I hereby certify that the above information on my application are true and correct to the best of my knowledge and ability. I understand that any false information may cause my disqualification from the program.
If selected as grantee, I commit to participate actively in all the program activities before, during and after the YES Program 2016-17.

__________________________________
Signature over printed name of applicant

__________________
Date

Parent/guardian's consent for the applicant to participate in the program

___________________________
Signature over printed name of father/guardian Date

__________________________
Signature over printed name of mother/guardian Date

____________________________________________________________________
SUBMISSION POLICY
All applications must be received by AFS PHI on or before August 20, 2015 (application deadline date) and must be sent to:
ATTN: SENDING PROGRAM
AFS Intercultural Programs Philippines
Unit 1607 16/F Antel Global Corporate Center
No. 3 Dona Julia Vargas Avenue, Ortigas Center
1600 Pasig City, Metro Manila, Philippines
Telefax: 02-5842002
Website: http://www.afs.ph
E-mail address: phi.sending@afs.org
NOTES:
1. All applications must be submitted to the AFS PHI office as printed copies; applications submitted online
(via email) will not be honored.
2. Applicants must submit only photocopy of original documents, AFS PHI will not be responsible in sending back original copies
3. Applicants who have family members (father, mother, sister or brother) and cousins within the first degree who have participated in the previous Bureau of Educational and Cultural Affairs – Department of State sponsored exchange programs are NOT qualified to participate in this program. This restriction applies as well to AFS PHI staff and board members up to the third degree.
4. AFS PHI will announce (and will notify) ONLY the semifinalists in September. Only semifinalists are invited to the interviews during the months of August to October.
5. For any inquiries and concerns re: YES Program application, etc. please send an email to AFS Philippines,
Email: phi.sending@afs.org; Subject: YES 2016-17 Inquiry
6. For more information and to download the application form, visit AFS PHI website: www.afs.ph and/or
United States Embassy in Manila website: http://manila.usembassy.gov/