YBB 2019 High School Application

Youth Building Bridges,
US-China Leadership Education Initiative
US High School Application

I. High School Student Information

* Indicates required field

Year *

Name *

First

Last

Birthday: (mm/dd/yyyy) *

sex *

Female Male Other

School *

Grade *

GPA *

PSAT/SAT *

Student Cell Phone Number *

Student Email *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Are you part of the Student Medical Association (SMA)? *

Yes No

II. Parent Information

Mother's Name *

First

Last

Father's Name *

First

Last

Mother's Email *

Father's Email *

Mother's Cell Phone Number *

Father's Cell Phone Number *

Home Phone Number *

III. Medical Insurance

Insurance Company Name *

Insurance Group Name *

Insurance Policy No. *

Insurance Phone Number *

Insurance Fax Number *

Insurance Address *

Line 1

Line 2

City

State

Zip Code

Country

IV. Primary Doctor

Doctor Name *

Doctor Phone Number *

V. Dentist

Choose School Preference *

Elementary School Middle School Both Elementary and Middle School

Dentist Name *

Dentist Phone Number *

VI. Emergency Care Information and Consent to Enroll

I certify that I fully understand the general rules of C&T Youth Technology Academy (CTYTA) and I agree to obey such rules. In case of an emergency, CTYTA has my permission to take my child to the emergency room of the nearest hospital if I cannot be contacted, and the hospital staff has my authorization to provide treatment that a physician deems necessary for the wellbeing of my child. I, for myself, my heirs, personal representatives, or assigns, do hereby release, waive, and discharge CTYTA, its officers, directors, employees, and agents from liability from any and all claims, including but not limited to, physical or mental injury, illness, death, and property loss arising, from participation in activities of CTYTA. I also understand my image may be used in all photos, video and other media under the YBB program. I consent to have my picture taken and used for YBB related content and materials.

VII. Program Participation Option

Program Option *

Programs Parts 1 - 3 Programs Parts 1 - 4

Choose Preferred Location *

Fu'Jian Gansu

* Note: Volunteers at the Fu'Jian location will NOT be able to participate in Program Part 4

VIII. Short Answers

1. What practical leadership or teaching experiences do you have? *

2. Have you had any tutoring or mentoring experiences? If so, describe such experiences. *

Essay 1

In an essay not to exceed 650 words, please address the following questions:

Why do you want to join the YBB program?
What do you hope to gain by participating in YBB?
Why should the board select you to become a YBB member?

Response to Essay 1: *

Essay 2

In an essay not to exceed 250 words, please answer one of the following prompts:

Describe an obstacle you have encountered and how you overcame such an obstacle.
Why is primary education so important to one’s fundamental growth?
What makes a teacher effective?
What makes you unique? How can you utilize it to contribute to the globe community?

Response to Essay 2: *

Interviews and Demonstration

All applicants will be asked to participate in an interview. Local students will be asked to appear in person, and non-local applicants will have online video interviews. The goal of this interview is to get to know each applicant, and to assure the selection board that the applicant is prepared for the challenges of traveling abroad, living in difficult conditions, and serving as a teacher/mentor.

As a part of the interview process, applicants will also be asked to prepare a five-minute demonstration of their teaching skills. Applicants can select any subject from the following to demonstrate: music, art, sports, math, English, etc. There is no right or wrong way to perform this demonstration. Local students will perform a live demonstration at the interview, while non-local students will be asked to send in their demonstrations via video. This does not need to be a difficult lesson, and the selection board urges you to be creative!

Student signature *

Date: (mm/dd/yyyy) *

Parent Signature *

Date: (mm/dd/yyyy) *

Submit

If you do not receive a confirmation email regarding your application submission within 24 hours, there may be a technical difficulty with the website. If this occurs, please send an email to ybb@ctyta.org regarding such a difficulty. Thank you.

Youth Building Bridges,
US-China Leadership Education Initiative
US High School Application

I. High School Student Information

II. Parent Information

III. Medical Insurance

IV. Primary Doctor

V. Dentist

VI. Emergency Care Information and Consent to Enroll

VII. Program Participation Option

VIII. Short Answers

Essay 1

Essay 2

Interviews and Demonstration

Home

About

Location

Donate

Contact Us

Youth Building Bridges,​US-China Leadership Education InitiativeUS High School Application

I. High School Student Information

II. Parent Information

III. Medical Insurance

IV. Primary Doctor

V. Dentist

​VI. Emergency Care Information and Consent to Enroll

VII. Program Participation Option

VIII. Short Answers

Essay 1

Essay 2

Interviews and Demonstration

Home

About

Location

Donate

Contact Us

Youth Building Bridges,
US-China Leadership Education Initiative
US High School Application

VI. Emergency Care Information and Consent to Enroll