Ansøgning EI USA. Din ansøgning er vigtig! Hvad er en god ansøgning? For at sikre at din ansøgning er komplet, kan du bruge denne tjekliste:

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1 Ansøgning EI USA Din ansøgning er vigtig! Din ansøgning bliver brugt til at finde den bedst mulige placering til dig. Alt hvad du skriver vil blive sendt ud til potentielle værter, derfor er det vigtigt at du er ærlig hele vejen igennem ansøgningen. Du skal hele tiden have fokus på, at din ansøgning skal give det bedste indtryk overfor en mulig vært. Derfor - gør dig umage! Hvad er en god ansøgning? 1. Ansøgningen skal være sandfærdig. Lad vær med at overdriv eller underdriv dine færdigheder og erfaringer. 2. Din selvbiografi (personal description) skal fylde ca. en A4-side. Fortæl om dig selv, din baggrund, og hvad du gerne vil opnå ved at tage et udlandsophold. 3. Billedet kommer forrest på din ansøgning. Brug derfor et ordentligt billede, hvor du ser professionel ud og smiler. Har du nogle spørgsmål til udfyldelse er du altid velkommen til at kontakte os! For at sikre at din ansøgning er komplet, kan du bruge denne tjekliste: Udfyldt Travel to Farm tilmeldingsblanket Udfyldt EI USA-ansøgningsskema Farvebillede Kopi af pas Kopi af kørekort 2 anbefalinger Uddannelsesbevis Selvbiografi (personal description) på engelsk CV på engelsk Straffeattest

2 Travel to Farm tilmeldingsblanket 1. Valg af land: 2. Personlige oplysninger Fulde navn Cpr-nummer Adresse Postnummer & by Telefonnummer Mobilnummer Køn (mand/kvinde) Status (single/kæreste/gift) Statsborgerskab Stilling: Kontaktoplysninger på pårørende ved nødstilfælde (navn, adresse, telefonnummer.) Studerende Udlært Andet 3. Rejsedatoer Hvor lang tid vil du være afsted (antal måneder): Start på ophold (dato): 4. Placeringsønsker Arbejdsområde du er interesseret i (skriv venligst hvad du er mest interesseret i: prioritet): Planteavl Malkekvæg Slagtesvin Kødkvæg Søer Heste Andet: Hvis du selv har fundet en placering i udlandet, skriv venligst navn, adresse, telefonnummer og på din kommende vært: Er dit ophold en del af praktikperioden på din uddannelse? ja nej Hvilket skoleforløb er du på? Hvilken skole går du på? Hvor har du hørt om Travel to Farm? Hjemmeside Foredrag på din skole Fra venner/familie Agromek Materiale på din skole T-shirt størrelse: S M L XL XXL Jeg erklærer hermed at jeg er indforstået med følgende: - Jeg skal købe en rejseforsikring til min rejse (arrangeret af Travel to Farm eller af den ansvarlige partner i praktiklandet). - Jeg vil informere Travel to Farm og værtsfamilien, hvis der sker nogle ændringer i mine rejseplaner, eller programlængde. - Jeg vil ikke skifte værtfamilie uden at konsultere partnerorganisationen eller Travel to Farm. - Jeg vil være en god ambassadør for Danmark og følge de instrukser som Travel to Farm har givet mig. - Jeg vil betale alle fakturaer sendt fra Travel to Farm (servicegebyr, flybillet, forsikring o. lign.) - Travel to Farm må kontakte mine referencer Jeg har læst og forstået annulleringsreglerne i informationsmaterialet. Jeg har forstået at jeg vil blive ekskluderet fra programmet og ikke vil få penge tilbage, hvis jeg forlader min praktikplads uden at informere Travel to Farm og partnerorganisation. Dato Underskrift

3 EXPERIENCE INTERNATIONAL Short Term Summer Immersion Program APPLICATION FORM INSTRUCTIONS 1. Complete this form and required attachments 2. Be sure to sign and date the last page. 3. Send all materials electronically as attachments to 4. Please follow the following format when entering dates: March 10, Thank you in advance for your application! We look forward to working with you! Participant Name (as it appears on your passport) Surname (family name) Today s date (example: February 1, 2010) First Name Other Names (as on your passport) Biographical Information Gender: Male Female Marital Status: Single Married City and Country of Birth Date of Birth (example: May 2, 1988) Country of Citizenship Country of Permanent Legal Residence I am a: Student (name current school below) Professional (list current occupation and employment). Current Occupation Current Job Title Permanent Address (Must be address outside the US) Street Address City Country Postal Code Home Telephone (Country Code)(City Code) Phone Number Current Address (EI Documents will be sent to this address) Street Address (No PO Boxes-MUST be physical address) City Check here if current address is the same as above. Country Postal Code Telephone (Country Code)(City Code) Phone Number Daytime or Work Phone Number Current Address is Valid Until (month/day/year) Skype ID Experience International * PO Box 680 * Everson, WA USA * ei@expint.org * Fax:

4 Passport & Visa Information Required Attachments * Scanned copy Passport * Copy of previous visas Passport Number Country of Issue Issue Date Expiration Date (month/day/year) (month/day/year) Have you visited the US in the last 3-years? YES No If YES, please provide the following information for each visit you had. (add pages if necessary) Type of Visa Held Purpose of Visit Entry Date to US Exit Date from US Type of Visa Held Purpose of Visit Entry Date to US Exit Date from US Have you ever been refused a visa to the US? YES No If YES, please provide the following information: (add pages if necessary) Type of visa refused Date of Refusal Emergency Contact (This must be someone in your home country that you authorize us to contact in the event of an emergency). Full Name Relationship to you Street Address Country Postal Code Telephone (Country Code)(City Code) Phone Number Knowledge of English Language Is English your native language? YES No If NO, rate your knowledge below. Speaking Poor Fair Good Excellent Reading Poor Fair Good Excellent Writing Poor Fair Good Excellent Education List the school(s) in which you are currently enrolled or from which you graduated. Please attach a separate sheet for others if needed MOST RECENT SCHOOL SCHOOL 2 School Name School Name City Country City Country Begin date (mth/year) Graduation Date (mth/year) Begin Date (mth/year) Graduation Date (mth/year) Field of Study Field of Study Degrees or Certificates Degrees or Certificates Experience International * PO Box 680 * Everson, WA USA * ei@expint.org * Fax:

5 Resume Required Attachment Resume or CV Resume or CV MUST Contain ALL of the following: 1. Career Goal: 1-2 sentences 2. Full Name, Date of Birth, Phone Number, , and Current Mailing Address 3. Work Experience: (starting with your most recent employment first) a. Employment: Company Name: Start/End Dates, Hours per week, Title; Responsibilities and Skills used b. Practical Training or Apprenticeships: Name, Dates, Description of activities c. Volunteer Work; Name, Dates, Description of activities d. International Work Experience; Dates, Country, Description of activities 4. Education: School Name, Dates, Degrees, Major Subjects 5. Personal Interests and Special Qualifications Placement Request Required Attachment Detailed Placement Request Please write a narrative (at least two paragraphs) describing the type of placement you seek. Your placement request MUST be in your academic/career field. To best assist us in your placement, please include: 1. Why are you interested in coming to the United States? 2. What kind of farm/business would you be most interested in and why? 3. What practical experience do you have in the type of placement you d like in the States? 4. What are you really excited about learning and doing at your placement site? 5. How will this summer experience help you when you return home? 6. If you have a confirmed placement already, explain how this host will help you achieve your career goals. Start Date Request Indicate first, second, and third choice of start dates. June July August Other: Self-Placed Applicants Do you have your own placement already? YES No Name of Company/Host Contact Name Contact Phone Contact Financial Information Participants in the short term immersion program are not allowed to receive any wages or work for money while in the USA. Please let us know how you will cover your personal expenses while in the United States. Will you receive grant/scholarship funding from your school or government to participate in the program? Yes No Amount USD$ Will you have personal funds (family/personal) to support yourself? Yes No Amount USD$ * Do you understand that you must have a round trip ticket to participate in the program? Yes No Experience International * PO Box 680 * Everson, WA USA * ei@expint.org * Fax:

6 Other Information Do you or do you have: Smoke? Yes No Driver s License? Yes No How many years have you been driving? Int l Driver s License? Yes No Have you ever been: Charged with a moving violation? Yes No Charged driving under the influence of alcohol? Yes No Charged with a misdemeanor or felony? Yes No Dismissed or fired from a job? Yes No Changed your legal name or held a passport Yes No in a different name? Health /Diet If you answer YES to any of the following, please describe/explain in detail on a separate sheet of paper. Yes No Do you have any sight, hearing, respiratory, asthma, physical handicap, mental or other health related concerns, that could or does limit your physical activity? Yes No Do you currently take medication for any reason on a regular basis? Yes No Have you ever had surgery or been hospitalized for any reason? Yes No Do you have any food allergies or intolerances? Yes No Are you a vegan or vegetarian?. Health Insurance Personal Accident & Health Insurance with Medical Evacuation & Repatriation is required. You have two options. (1) Insurance through EI or (2) Insurance through our Program Partner if it is approved in advance. Which do you choose? I will enroll in CISI Health Insurance Policy provided by EI I request permission to obtain home country insurance through EI s Partner in my home country. Submitting Application We thank you in advance for your application to Experience International. Please know we will do everything we can to review and respond to your application as promptly as possible; and we encourage you to contact our Partner in your home country whenever questions arise. If they are unable to answer your questions, please contact EI directly! Please be sure that you ve sent all the following documents: Completed Program Application Signed/Dated Obligations & Responsibilities Page Detailed Placement Request Copy of Passport and Previous Visas to US Resume/CV Letter of Reference Anything More? Please use the following space to let us know any special requests you have; any questions we might answer for you; or just tell us anything you think we or your host might like to know about you that you ve not already told us about! Experience International * PO Box 680 * Everson, WA USA * ei@expint.org * Fax:

7 Program Terms and Conditions In order to participate in the program, you must accept the responsibilities and obligations outlined here. Your signature means that you understand and agree to the conditions as stated. If you have any questions please be sure to ask our Program Partner. PARTICIPANT OBLIGATIONS AND RESPONSIBILITIES Please read the statements below, then sign and date the application to indicate your understanding and agreement before sending to EI. I agree to the following: I understand that the purpose of this program is cultural immersion on a farm or in a business related to my field of study and future career interests; that this is not a work program, and that I will observe and participate in the daily life of the business, family and community where I am placed; that this is an opportunity to learn how a farm or business operates; to practice and improve my English; to engage in cultural exchange; and to travel and learn about the United States. I agree to seek opportunities to participate in cultural events and to share my culture with others. I will act as an ambassador ; uphold the highest level of conduct; will not abuse alcohol or use non-prescription drugs; nor have sexual relations with minors. I will not partake in unsafe actions/behaviors that endanger myself or others. I understand that I am on a B1/B2 visitor visa and will comply with all rules and regulations that apply to my visitor status; and, that I understand the visa does not allow me to work or receive any wages while in the United States. I recognize that I am responsible to EI during my immersion program. I agree to provide EI with my date of entry to the United States and promptly inform EI of any change in travel plans. I also acknowledge that EI must approve in advance any changes in my program. I understand that I must be covered by personal health and accident insurance that includes medical evacuation and repatriation coverage; and that I must promptly report any accidents or medical situations to EI. I also understand that this coverage must be in effect from the moment of departure from my home country to the moment of return. I understand that I must complete a final evaluation of my placement and program before departing the United States. I understand that EI and its partners assume no liability for injury, accident or other events that may lead to illness or disability. I certify that I have disclosed any and all physical and/or mental health issues that may affect my participation in the program. I understand that EI will do all it can to ensure I have a fun, safe, and productive learning and immersion experience in the United States; and that it is my responsibility to promptly inform EI of any concerns or problems I might encounter so that they can be resolved. I certify with my signature below, that I have read and understand my obligations and responsibilities and that the information I ve provided in this application is complete and true. I understand that providing false or incomplete information may result in termination from the program; and that if this happens, I will receive no refund of fees paid to EI or to the country partner. Signature: Date:. Full Name (please print): Experience International * PO Box 680 * Everson, WA USA * ei@expint.org * Fax:

8 Indsæt farvebillede

9 Indsæt kopi af pas

10 Indsæt kopi af kørekort

11 Indsæt 2 anbefalinger

12 Indsæt uddannelsesbevis f.eks. grundforløbsbevis, hovedforløbsbevis eller faglærtbevis

13 Indsæt selvbiografi (på engelsk) Selvbiografen skal være på ca. en A4 side, hvor du på engelsk fortæller om dig selv, din arbejdserfaringen inden for landbruget, din familie, fritidsinteresser, fremtidsplaner, hvorfor du gerne vil tage din praktik i USA/hvad du vil opnå hermed (f.eks. at du vil være landmand i fremtiden/have din egen gård o.l.), dine styrker og svagheder osv. Det er vigtigt at du skriver hvorfor det er en fordel for dig at tage din praktik i udlandet - fx for at styrke din fremtidige karriere indenfor landbrugsfaget. Brevet bliver sendt med til din kommende værtsfamilie, når vi sender din ansøgning videre til USA, og skal desuden også bruges til visum ansøgningen.

14 Indsæt CV - nedenstående eksempel kan bruges som skabelon CONTACT INFORMATION Name : Address: Telephone: Cell Phone: PERSONAL INFORMATION Date of Birth: Marital Status: CAREER GOAL Please explain in 1-2 sentences what your future career goals and plans are. Example: Through my education as a skilled farmer I hope to get a through understanding of my speciality within Dairy cattle. I expect to become a front runner for usage of new innovative ways of production, and therefore I wish to take some of my trainee period overseas to get a different perspective. EMPLOYMENT HISTORY List in chronological order (beginning with your latest employment), include position details and dates. Please also include what skills you gained during your work experience. Example: March April 2009: Travel to Farm Student position at Travel to Farm, working 15 hours a week. Travel to farm is a non-profit organization, servicing Danish agricultural trainees who wish to go abroad during their education. I have been in charge of the administration of trainees and updating the webpage. During my time at Travel to Farm I have gained skills within administration and servicing. Furthermore I have also gained knowledge within Danish agricultural council. EDUCATION Include dates and details of education, training, major courses and certification(start with your latest education) September July 2008: Agricultural management August July 2005: Skilled farmer August august 2004: Agricultural training at pig farm. PROFESSIONAL QUALIFICATIONS Courses: spraying certificate, first aid certificate. Computer Skills: excellent user of Exel, powerpoint and word. Language skills: Danish fluent in writing and speaking, English fluent in writing and speaking, Limited German. EXTRACURRICULAR WORK May present: active member of LU ( agricultural youth organization) January January 2007: volunteer worker for Red Barnet.

15 PERSONAL INTERESTS PRIOR TRAVEL TO HOST COUNTRY (the country you wish to travel to) Please write dates of entry/departure, if you have been in the country before. HAVE YOU EVER BEEN DENIED TRAVEL TO HOST COUNTRY? CRIMINAL RECORD Have you ever been charged or convicted of a crime? If so, please explain

16 Indsæt straffeattest