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Applicant Information


Preferred Country*


If you have a preference for Kiev, please check here



Term*


Legal Name:

First*



Middle



Last*



Maiden Name



Preferred Name



Birthdate (mm/dd/yy)*



Birthplace (City, State)*



Citizenship*


Other



Social Security #



Gender*


Female


Male


Marital Status*


Single


Married


Native Language



Current Address*



City*



State*


Zip Code*



ILP can contact me at my current address until:*



Phone Numbers

Current phone:*



Cell



Work



Permanent Address*



City*



State*


Zip Code*



Permanent Phone*



Permanent Fax



E-mail Address:
*


Alternate Email Address



Parents/Guardians

Parent/Guardian #1

Name*



Address*



Phone*



Parent Email



#2

Name



Address



Phone



Parent Email



College/University*



Major



Minor



Year


GPA



Admission Date



Graduation Date



Where did you learn about this program?*



Names of friends applying with you:



Names of former ILP participants whom you know:




Countries visited in the last 10 years:


Country #1



Dates



Purpose



Country #2



Dates



Purpose



Country #3



Dates



Purpose



Other countries visited



Do you have a passport?*


Yes


No


Passport #



Issue Date



Expiration Date



Issuing Authority



PLEASE NOTE: our program is based on travel regulation and costs pertaining to U.S. passport holders. Applicants who are native speakers of English and reside in North America, but who are not American citizens, may participate in the program, but may have additional requirements, costs, or limitations depending on differences in visa requirements, flight costs, or other travel aspects.

Please check here if you are not a U.S. citizen or cannot obtain a U.S. passport:




Please list below involvement and achievements that you think will help you be successful in this program. Be sure to include any long-term service such as the Peace Corps, a religious mission, etc. Categorize you experience in the following categories:1-Academics, 2-Athletics, 3-Performing Arts, 4-Teaching/Instruction, 5-Public Speaking/Leadership, 6-Volunteer Service, 7-Other


Category:



Description



Duration



Achievements/Special Performances/Awards



Category:



Description



Duration



Achievements/Special Performances/Awards



Category



Description



Duration



Achievements/Special Performances/Awards



Please list medical conditions or dietary restrictions (e.g. medications, physical or emotional illness, allergies to food, etc.)



ILP upholds a standard of appearance appropriate for teaching young children. Please describe all piercings or tattoos you have (location, size, object represented, etc.)



Are you currently on probation, parole, or under restriction with any court, or have you ever been convicted of a crime (other than a traffice violation)?*


Yes


No


Have you ever been accused, tried, or convicted or child abuse or any illegal activity involving a minor?*


Yes


No


Providing inaccurate information or failure to disclose requested information is grounds for dismissal from the program.


Employment Record:


Company/Employer #1



Position



Supervisor



Address



Phone



Dates (from/to)



Hours per week worked



Company/Employer #2



Position



Supervisor



Address



Phone



Dates (from/to)



Hours per week worked



Company/Employer #3



Position



Supervisor



Address



Phone



Dates (from/to)



Hours per week worked




References
:


As part of this application, you are asked to submit two references. Once you submit your application, copies of the reference forms will be emailed to you. You or your reference can also access the forms on our website in the How to Apply section. Please complete your reference information below. If you have questions about who can complete these references for you, please call the office.


Character Reference Form to be completed by



Phone



Your character reference should be completed by your current ecclesiastical leader. If you will have someone toher than your current ecclesiastical leader complete your reference, please explain why (subject to director approval):



Academic Reference Form to be completed by



Phone



Your academic reference should be completed by a teacher or professor who has taught you in the last two years. If you will have someone other than a teacher or professor complete your reference, please explain why (subject to director approval):



Helpful hints for reference forms: Since people who fill out references are typically busy, give the form to them first thing! You might suggest that your references fax the completed form to us as it saves time. Our fax number is located at the bottom of the form. If you would like your reference to mail the form back to us, include a stamped envelope with the ILP address on it.

Tell Us About Yourself: in the box below, please tell us a bit about your family and background, and explain why you are interested in participating in the ILP program and what you feel you can contribute to the program.*


Interview
:


The purpose of the interview is to provide ILP with an opportunity to learn more about you. The interview takes 20-30 minutes and informal dress is appropriate. We prefer that these interviews be conducted in person. If you live outside of the Wasatch Front, we can conduct the interview by phone. Call the ILP office at (801) 374-8854 or (800) 349-1846 to schedule an appointment (you may also go to the How to Apply section of the website to schedule the interview online.) Its a good idea to schedule your interview right away.



Please read the following information carefully.



Code of Personal Conduct:


ILP volunteers are responsible to understand and uphold the following moral standards--Abstain from alcohol, tobacco, and drugs. Be chaste in all relationships. Obey the law. Avoid vulgar and profane language. Follow all rules and help other volunteers do the same.


Rules

1. ILP volunteers should avoid traveling alone. In taxis or after 9 pm, they must be in groups of 3 or more.

2. ILP volunteers are to exchange money only at officially approved exchange points.

3. ILP volunteers should not associate with people who threaten the safety and/or standards of the group or an individual (as defined by the Regional Administrator).

4. ILP volunteers may not be involved in relationships or behavior perceived by others as romantic, and may not pair off (be alone or exclusive) with others.

5. ILP volunteers should remain politically neutral in their conversations as well as their activities.

6. Volunteers may not miss teaching for any reason other than illness.

7. Volunteers may not allow teaching to be filmed, recorded, or copied in any way without the consent of the Program Directors. This includes giving copies of the book, teaching episode manuals, and any other pages of material.

8. ILP volunteers must have travel plans (outside of the city) approved by the Head Teacher and Regional Coordinator. Information necessary for approval: location, traveling companions, means of transportation, contact information in case of an emergency, and return time to school.

9. ILP volunteers must follow all travel advisories and warnings issued by the U.S. government. (You may obtain a list of these advisories by calling the U.S. embassy.)

10. ILP volunteers may not receive compensation for services rendered in or out of the schools (i.e. teaching English to outside groups, accepting full or part-time jobs, etc.)

11. ILP volunteers must refrain from making any sort of religious proselytizing or solicitation, and from distributing literature that could be construed as having religious content (where such actions are forbidden by law or by ILP Head Teachers or Coordinators.)

12. ILP volunteers agree to follow all reasonable curfews and/or rules given by the Head Teacher and/or Advisor(s).

13. ILP volunteers must live with common courtesy, respect of property, and maintain a personal commitment to conduct life in a responsible, professional, and mature demeanor in and out of the school.

If there are violations of the Rules or Code of Conduct, Head Teachers and Regional Coordinators will work with those concerned to arrive at a solution. In rare situations, if deemed appropriate, the ILP Directors and Board of Trustees may dismiss a teacher for violation of rules or code of conduct. Head Teachers and Regional Coordinators are required to report any violation or suspicion of violation of the rules to ILP Directors. We also ask that any volunteers e-mail the ILP office if they have concerns regarding the conduct of their Head Teacher in relation to the rules and code of conduct. All e-mail of this nature will be kept completely confidential unless permission is given otherwise from the volunteer.

I have read and understand the above Code of Conduct and Rules. I agree to follow this Code of Conduct and Rules, as well as instructions given by my administrator or designated supervisor. Type *I agree*
*






*



Required