Student application form



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A Program of Empower Peace
Women2Women – America 2016

International Leadership Program

July 21 – July 30, 2016

Wheelock College

Boston, Massachusetts, USA


STUDENT APPLICATION FORM
Conference Information
The Women2Women International Leadership Program (W2W 2016) is a program of Empower Peace. W2W 2016 is an opportunity for young women ages 15-19 to participate in an educational cultural exchange in Boston, Massachusetts, USA. W2W 2016 will provide participants with the educational opportunity to learn, network and acquire leadership skills that will empower them to make a difference in their respective communities and countries. Participants will also have the opportunity to meet and develop friendships with their peers from around the world. 
Over the past 11 years, more than 900 young women from over 60 countries have participated in the program since 2006.  APPLICATION DEADLINE: FRIDAY, APRIL 15, 2016 AT 5:00 PM.
Women2WomenAmerica 2016 International Leadership Program

The Women2Women – America 2016 conference will focus on how you can “Claim Your Seat at the Table” and empower other young women to do the same. You will have the opportunity to learn about the current status of women and girls around the world, as well as the social and economic progress that is possible when women and girls have the opportunity to participate fully in every aspect of society. You will meet with leading figures tackling these challenges on an international scale, and develop your leadership skills so you can make a difference. Perhaps most importantly, you will be joining a lifelong, global network of young women who support each other and work together to contribute to positive change around the world.


The Challenges

Despite much progress, women and girls are still the most discriminated-against group in the world. Consider these facts:



  • Of the 1 billion people living in absolute poverty around the world (unable to secure basic life necessities), 60% are women and girls.

  • Women contribute 2/3 of the world’s working hours, yet earn only 10% of the income.

  • An extra year of primary school education boosts a girl’s eventual wages by 10-20%. An extra year of secondary school adds 15-25%.

  • There are 31 million girls of primary school age not in school. Of these, 17 million are expected never to enter school

  • Worldwide, nearly 50% of all sexual assaults are against girls aged 15 years of younger.

  • 1 in 3 girls will experience some form of violence in their lifetime.

  • Around the world, 120 million girls under 20 have experienced forced sexual intercourse or some other form of sexual violence.

  • Every year 800,000 people are trafficked across national borders. 80% of the victims are women. 50% of the victims are minors.

  • 1 in 7 girls in the developing world will be married before her 15th birthday.

  • Every minute of every day a pregnant woman dies from mostly preventable causes.

  • Women earn 79 cents to every dollar earned by a man.

Unfortunately, there is no community in the world that is untouched by these issues. It’s time to come together and make a difference.


The Solutions

While the statistics above are shocking, so too are the results when women and girls are able to participate fully in society. Women involved in the political, social, and economic life of their countries and communities are better-positioned to increase attention for women’s rights. Simply providing women and girls with an education can lead to healthier families and children, less poverty and stronger national economies. Education also equips women with the knowledge and skills needed to realize their potential and protect themselves from harm. By participating in W2W 2016, you will learn how to claim your seat at the table and become part of the solution.


Schedule

W2W 2016 will take place from July 21, 2016 through July 30, 2016. July 21st and July 30th considered travel days. International participants may begin their travel to Boston as early as July 19th.



2016 Women2Women Schedule
The conference will include: team-building activities; seminars and workshops with prominent leaders doing important work in government, media, business, science and technology, and non-profit; leadership development exercises and skill-building; outreach events with other youth and community leaders; and cultural activities. Participants are required to partake in all conference activities.
Transportation/Visas

If you are coming from within the United States…

  • Empower Peace will provide all participants (other than those from Massachusetts, New Hampshire and Rhode Island) with round-trip transportation from an airport near their home to Boston’s Logan International Airport. All participants will be fully responsible for transportation to and from their local airport.

  • Empower Peace will all greet participants at Logan Airport in Boston and bring them to the conference.

  • Transportation for all conference activities will be arranged through Empower Peace.

  • Participants from Massachusetts, Rhode Island and New Hampshire must obtain their own transportation to and from the conference.

  • Empower Peace WILL NOT accommodate any requests to extend a participant’s stay in Boston. All participants must depart Boston on their scheduled flight from Logan Airport.


If you are coming from outside the United States…

  • If selected to attend W2W 2016, you must obtain your passport and secure a visa interview as soon as possible. Participants should look to apply for a (B-2) tourist visa.

  • Empower Peace will provide all participants with round-trip transportation from an airport near their home to Boston’s Logan International Airport. All participants will be fully responsible for transportation to and from the airport in their home country.

  • Empower Peace will provide necessary documentation to help secure a travel visa interview to travel to the US. International participants will receive an acceptance letter with all the details about where you will be staying and what Empower Peace will be providing.

  • Transportation for all conference activities will be arranged through Empower Peace.

  • Empower Peace WILL NOT accommodate any requests to extend a participant’s stay in Boston or the United States. All participants must depart Boston on their scheduled flight from Logan Airport.

  • Participants are responsible for obtaining their own travel and airport transit visas. Some participants may need to obtain an airport transit visa – a visa required to wait for a few hours at the airport’s international transit area.

  • Empower Peace will greet all participants at Logan Airport in Boston and bring them to the conference.


Housing/Meals

  • All participants will be housed in dorms at Wheelock College in Boston, Massachusetts, USA during the entire conference. Wheelock College is approximately 7 miles (about 11 km) from Logan Airport, near Fenway Park. (Approximately 20 minutes drive)

  • Students are expected to abide by all Empower Peace and Wheelock College dorm rules. Rules will be provided in check-in materials.

  • Students will have at least one roommate from another delegation/country.

  • Students are not allowed to switch roommates or rooms.

  • Students will be living in an area shared by other Wheelock College students (non-conference participants).

  • Students will share a bathroom with one other room on the floor.

  • Empower Peace will provide all meals during the conference. Halal food will be available on a limited basis. We will do our best to accommodate your needs. Please indicate if you require Halal or kosher food. Please indicate if you have any food allergies (ie. gluten, nuts, etc.) in the application.


Health Insurance

Empower Peace will provide all international participants with basic travel/health coverage. Participants will be responsible for any charges/co-pays associated with a medical visit. Coverage will begin on the day they travel to the United States and will end on the day they return home.


Financial Responsibilities
Conference Fees
Cost per participant: $2,800 + airfare
There are limited hardship scholarships available for qualified applicants who cannot afford the conference fee. We strongly encourage ONLY those candidates that are in need to apply for a scholarship. We encourage everyone to apply even if you cannot afford the conference fee.
Costs covered by Empower Peace

  • Food

  • Lodging

  • All conference materials

  • All conference related activities and ground transportation

  • All costs connected to speakers, and conference development and implementation

  • Basic health coverage (for all international participants)

  • Empower Peace will not cover costs associated with the travel and airport visas or passport application process.


Costs covered by the participant (her family, and/or sponsoring agency)

  • Air travel to and from the conference

  • Costs associated with securing passports

  • Costs associated with securing visas – travel and airport transit (approximately $160 USD)

  • Transportation to and from airport in participant’s home country/state

  • Incidental costs

  • Conference fee (if you have not received a scholarship or are not sponsored)

  • Empower Peace will not cover costs associated with the travel (luggage fees, airport transit visas, travel visas or passport application process.)

  • Health insurance deductible and or outstanding balances not covered by health insurance – should the participant require medical care or hospitalization


Application Requirements/Process
Young women, between the ages of 15-19 as of July 1, 2016, in the United States and around the world are welcome to apply for the Women2Women – America 2016 conference.
The conference will be entirely conducted in English; therefore, participants must have a strong ability to speak and understand English.
In addition, Empower Peace is looking for applicants with the following abilities/interests:

  • learning about other cultures, religions, and countries

  • political science/government, world events, media/journalism, community activism and/or business

  • active in community service activities and/or extracurricular activities

  • willing and able to work with a variety of individuals and teams from many different cultures, backgrounds and religions

  • demonstrate solid leadership qualities and abilities

  • make the most of this opportunity and share their experiences with others in their schools and communities when they return home


Women2Women alumnae are not eligible to apply as student participants.
Applications must be submitted via email to: culture_warsaw@state.gov by FRIDAY, APRIL 15, 2016 AT 5:00 PM. Final selections will be made, and applicants will be notified (by e-mail or phone), no later than FRIDAY, MAY 13, 2016. Final acceptance for this conference will be made with consideration to the diversity of geographic, racial, ethnic, religious and socioeconomic backgrounds represented in the full group of participants.


APPLICATION

SPONSORED BY: US Embassy Warsaw/US Consulate Krakow

EMPOWER PEACE


  • Complete the following application form. Please type or print clearly with a pen in ENGLISH.

  • Applications must be received by FRIDAY, APRIL 15, 2016 at 5:00 PM

  • Applications may be submitted by email to: culture_warsaw@state.gov


Please type your responses in the gray boxes

           



Name as it Appears on Passport or License (if Applicable) Date of Application (Day/Month/Year)
           

Home/Street Address Telephone Number (Include Country Code)


                       

City Province/State Postal Code Country


                 

Date of Birth (Day/Month/Year) Place of Birth (City, State, Country) Citizenship


     

E-mail Address (Please Print Clearly)

Please Check One:
 I am a United States citizen.

 I am not a United States citizen but am currently attending school/college in the United States.

 I am not a United States citizen and am not attending school/college in the United States.
Have you applied to the Women2Women Conference before?  YES  NO
If Yes, please tell us what year you applied.  2006  2007  2008  2009  2010  2011

 2012  2013  2014  2015 – America  2015 – Belgium


Passport and Visa Information

Do you currently hold a valid passport?  YES  NO


If yes, what country is your passport issued by?      


What is your passport number?      




What is the expiration date on your passport?      






If you hold a valid passport, please attach a clear copy of the picture page of your passport to this application if possible.
Have you ever obtained a travel visa?  YES  NO
If yes, please list visa country and dates acquired.
     

School Information

           

Name of School/College/Organization Current School Year or Occupation
     

High School and/or College Attended (If not currently a student)


     

Major Subjects/Academic Interests


     

Degree Earned (if applicable)

Please tell us how you heard about Women2Women – America 2016 (US Embassy, e-mail, flyer, web site, at a conference, from a teacher, friend, parent, word of mouth, etc.)
     

Please tell us about any extracurricular activities and community service programs you participate in. (Please use additional paper if necessary. Additional sheets MUST be labeled with your name and attached to this application.)


     

These personal statements help us become acquainted with you. It will demonstrate your ability to organize your thoughts and express yourself. If you require additional space, please use a separate sheet of paper. Additional sheet(s) MUST be labeled with your name and attached to this application. Please try to limit your responses to 500 words for each question.


  1. Tell us about yourself. Share with us something you have accomplished of which you are proud.

     



    1. This conference attracts emerging leaders from all over the world, reflecting diverse cultures, religion and opinions. How do you see yourself engaging in this experience?

     



  1. We will be discussing important issues affecting women and girls around the world. What are some ways you can share your experiences with others in your school and community?

     
One key element of Women2Women – America 2016 will be a discussion on women’s rights. The term “women’s rights” refers to the freedoms inherently possessed by women and girls of all ages, which may be institutionalized, ignored or suppressed by law, custom, and behaviors in a particular society.


  1. To that end, what do you consider to be the most pressing women’s issue confronting women in your country?

What do you consider to be the most pressing women’s issue today for women everywhere?

     


Conference Fee and Scholarship Information
There is a $2,800 (USD) conference fee for all non-sponsored participants to partially cover housing, conference and transportation costs. A limited number of scholarships are available. If you do not receive a scholarship, you are still welcome to attend but you must be able to provide the #$2,800 conference fee.
Would you like to be considered for a scholarship?  YES  NO
If you would like to be considered for a scholarship please tell us why you should be considered for a scholarship. (Maximum 200 words – Additional sheets MUST be labeled with your name and attached to this application.)
     

In order to monitor and promote the participation rate of women from various racial, cultural, and religious backgrounds, we request that you provide the following information. You are not required to respond. (Optional)


Racial/Ethnic Background (Check one)

 American Indian or Alaska Native  Hispanic or Latina

 Asian  Native Hawaiian or Pacific Islander

 Black or African American  Arab

 White or Caucasian  South Asian

 Arab


 Other: Please specify      

Religious Background (if any):      


I certify that the above statements to be true and correct, and to the best of my knowledge the information in my application, including my essays, is my own work, factually true and honestly presented. I understand that the information provided in this application will be used for the purpose of processing my W2W application.
           

Signature of Applicant Date (Day/Month/Year)



Empower Peace will review all completed applications. By submitting this application to the Women2Women International Leadership Program, I understand that I am not guaranteed attendance.

HEALTH HISTORY

WOMEN2WOMEN – AMERICA 2016
                 

First Name Middle Initial Last Name

In Case of Emergency, please notify:

                 

First Name Last Name Relationship to Applicant

     


Address

                       

City State/Province Postal Code Country

                 

Home Phone Work Phone Cellular (Mobile) Phone (if applicable)

(Please include country code) (Please include country code) (Please include country code)

Are you physically disabled?  YES  NO
I use :  Wheelchair  Cane  Metal Walker  None  Other

Please specify:      

I am:  Blind or visually impaired  Accompanied by a guide dog  None  Other

Please specify:      
I am deaf or hearing impaired:  YES  NO
I require a sign language interpreter:  YES  NO  Other

Please specify:      


Dietary Information
Do you require Halal meat?  YES  NO
Do you require a Kosher diet?  YES  NO
Do you have any dietary needs?  YES  NO
Please tell us about your dietary needs?

     
Do you have any food allergies (ie. gluten, nuts, fruits)?  YES  NO


Please tell us about your food allergies.

     
Do you have any health problems that we need to be aware of?  YES  NO

If yes, please describe your health problems below:

     


If you have any allergies, please list your allergies below.

     


Please list any medications that you are taking at the present time or will be taking during the conference:

     


I certify that to the best of my knowledge I am in good health and able to participate in this conference. I certify the above statements to be true and correct, to the best of my knowledge.

           

Signature of Applicant: Date (DD/MM/YYYY):
Signature of:       Date (DD/MM/YYYY):      

Parent/Guardian



(Mandatory if Applicant is Under the Age of 18)

EMPOWER PEACE WOMEN2WOMEN – AMERICA 2016 PARTICIPANT RELEASE FORM
Dear Applicant:
Women2Women – America 2016 (W2W 2016) is a program of the Women2Women International Leadership Program, and is an event sponsored by Empower Peace and numerous other corporate and community entities. This multimedia event is a unique combination of education, leadership training, entertainment, interactive dialogue, and inspiration. If you need additional information about this event, please contact Kari Johnston at +1.617.912.3817 or kjohnston@empowerpeace.org.
Participant’s Name (as it appears on Passport or License):      


Name of School/College/Organization:      




Home Address:       Country:      




City:       State/Province:       Postal Code:      




Home Phone (Include Country Code):       Mobile Phone (Include Country Code):      




E-Mail Address:      




Please check all that apply:

 Wheelchair Access  Sign Language Interpretation  Other Services
If you checked “Other Services,” please explain:      

If selected, I hereby agree to participate in W2W 2016 from Thursday, July 21, 2016 through Saturday, July 30, 2016, based at Wheelock College in Boston, Massachusetts, USA. I understand that I will be returning home on Saturday, July 30, 2016. I understand that I am to attend all proceedings that are part of this conference. By signing this, I am granting my permission to be photographed on film or videotape for use in any Women2Women International Leadership Program and/or Empower Peace fund-raising or educational materials.

           

Signature of Applicant Date (Day/Month/Year)


Parent/Guardian Consent

To be completed for all participants under the age of 18 before July 1, 2016.


I hereby grant permission for the individual named above to participate in Women2Women – America 2016 from Thursday, July 21, 2016 through Saturday, July 30, 2016 based at Wheelock College in Boston, Massachusetts, USA. I understand that the individual named above will be returning home on Saturday, July 30, 2016 and is to attend all proceedings that are part of this conference. By signing this, I am granting my permission for the individual named above to be photographed on film or videotape for use in any Women2Women International Leadership Program and/or Empower Peace fund-raising or educational materials.

                 



Signature of Parent/Guardian Relationship to Applicant Date (DD/MM/YYYY)




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