Apply for a Program

Youth Delegate Application Form 2026

Thank you for your interest in CISV! Please complete the entire application, including the reference form linked here. Each youth applicant will require two references. Please provide each of your references with this link:

Program you are applying for:(Required)

Name of Youth Delegate:(Required)

First Last

Gender Identity:(Required)

Date of Birth of Youth Delegate:(Required)

Address of Youth Delegate:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Youth Email:

Youth Phone Number:

Grade in School:(Required)

Does the youth speak a language other than English. If so, describe fluency level.(Required)

What are your (youth applicant's) interests and hobbies?(Required)

How did you learn about CISV?(Required)

What is your CISV background?(Required)

Upload a photo of the youth applicant:(Required)

Max. file size: 20 MB.

References

Parents, please send this reference form to two non-related adults who have known and have worked with your child. The link to the reference form is: https://michcity-lakeshore.cisvusa.org/invitation-list/2026-youth-delegate-reference-form/

Parent/Guardian Information

Name of Parent/Guardian #1 (Parent #1 is CISV's primary contact for the youth applicant)(Required)

First Last

Parent/Guardian #1 Phone Number(Required)

Parent/Guardian #1 Email(Required)

Parent #1 Employer(Required)

Parent/Guardian #1 Occupation(Required)

Address of Parent/Guardian #1 (if different from youth applicant)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Parent/Guardian #2

First Last

Parent/Guardian #2 Phone Number

Parent/Guardian #2 Email

Parent #2/Guardian Employer

Occupation of Parent/Guardian #2

Parent/Guardian #2 Address (if different from youth applicant address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

CISV requires that both custodial parents/guardians sign this application form:

CISV requires that both custodial parents/guardians sign this application form (see last page for signature lines), thus confirming that the applicant has permission from both custodial parents/guardians to travel. If an applicant is selected, all additional required CISV forms can be signed by just one custodial parent/guardian, unless CISV is informed in advance of custody issues that make necessary the signatures of both.

Check the option that best describes your situation:

Parents/guardians are married.

Parents/guardians are divorced and share legal custody.

Parents/guardians are divorced and one has full legal custody.

Parents/guardians are not married but share legal custody.

Parents/guardians are not married and one has full legal custody.

Non-parent legal guardian has full legal custody.

If one parent/guardian has custody, name of that person:

Parent/Guardian response: why do you want your child to participate in CISV?

What are Parents'/Guardians' current volunteer activities?

Please describe each parent/guardians volunteer activities.(Required)

CISV is run entirely by volunteers. Being an active volunteer in our chapter is taken into consideration in our selection process for delegates.

Please describe your willingness to volunteer and how your would like to be involved.(Required)

If your child has previously participated in a CISV program, please describe how you have volunteered and supported the chapter in the past 18 months.(Required)

Child's Medical History

Does the youth applicant have any health issues? If so, please elaborate. If not, please write none.(Required)

Does your child take prescription medications? If so, please elaborate. If not, please write none.(Required)

List any allergies or their severity or youth's reaction. If none, please write none.(Required)

Please describe any dietary restrictions. If none, please write none.(Required)

Please describe any mental, physical or other conditions of the youth applicant.(Required)

What is the youth applicant's swimming ability?

Well. Youth applicant is good swimmer.

Some. Youth applicant has some swimming ability.

None. Youth applicant cannot swim.

If your child is selected, a physician’s declaration of your child’s health and fitness for CISV participation will be required.

NATIONAL CODE OF CONDUCT AGREEMENT

The child applicant will agree with CISV Michigan City Lakeshore Chapter and the National and International officers of CISV (1) to participate fully in the Village, Step Up, Youth Meeting, Fortnight, or other CISV program, (2) abide by the guidelines established by CISV International, INFO FILE R-07, in such manner that will enhance participants' life together and foster courtesy and understanding between us all; (3) not bring or use illegal drugs; (4) to participate in all CISV activities (games, culture sharing, crafts, singing, dances, meetings and workshops, etc.); (5) to participate to the best of their ability; and (6) to represent my CISV Chapter in a manner that is consistent with the values of the participant's home, community and country.

Do you understand and agree with the National Code of Conduct?

Yes, I understand and agree.

No, I do not agree.

Here are key elements of the CISV Child Behaviour Policy:

As a child in CISV, I WILL:(Required)

I Will NOT:(Required)

Pick on or make fun of others

Bully others

Get involved in peer pressure or push others into something they do not want to do.

Be mean

Break the law

I have the right to:(Required)

Be and feel safe

Be listened to

Be respected and treated fairly

Be protected from abuse by other member or outside sources

Participate on an equal basis, appropriate to my ability

Be believed.

Ask for and get help

I understand that CISV programmes and activities are not the place for sexual behaviours or relationships.(Required)

I understand and agree.

I understand and agree to follow this Code of Behavior. I understand that if I don’t follow this Code, there may be serious consequences: I may have to leave the CISV activity or program and I might lose my CISV membership temporarily or forever.(Required)

I understand and agree.

NATIONAL TRAVEL POLICY

1) Village, Step Up, and Interchange delegations shall travel to and from the site of the approved CISV activity as a group. Travel shall be direct and continuous to and from the CISV activity site. No side trips shall be permitted. No layover in excess of 24 hours shall be permitted unless common carrier schedules require otherwise. Delegation itineraries must be approved by the local Chapter. 2) Penalties - Violations of Section 1 will result in disciplinary action against the Chapter or Steering Committee pursuant to the complaint procedure (83-BOT-2) of CISV, Inc. 3) Individual travel (as in the case of Junior Counselors and Seminar Camp and Youth Meeting participants) other than to and from the site of an approved CISV activity shall be deemed non-CISV travel. CISV assumes no responsibility or liability for an individual while on a side trip or layover in excess of 24 hours.

Do you agree with the National Travel Policy?

Yes, I agree.

No, I do not agree.

IN SIGNING THIS APPLICATION, WE (APPLICANT AND PARENTS/GUARDIANS) CONFIRM THAT:(Required)

We have read, understand, and agree to abide by the National Code of Conduct Agreement and the CISV USA Travel Policy.

The information we have provided in this application may be verified by contacting individuals and agencies other than those listed in this application.

We release and hold harmless any individual or organization that provides additional information about us to CISV. We also hold harmless any officers or volunteers of CISV International, CISV USA, or the local Chapter of CISV.

All information provided on this application is true and correct.

My child will attend one of two selection dates in order to be considered. Dates 01/19/26 (South Bend, IN, time TBD) or 02/08/26 (location TBD, time 1:00-3:00 est).

IN SIGNING THIS APPLICATION WE ALSO AGREE TO PAY ALL ASSOCIATED FEES WITH TRAVEL BY THE POSTED DUE DATES.(Required)

Village $2,035.00 (not including airfare)

Youth Meeting $1,725.00 (not including airfare)

Step Up $1,910.00 (not including airfare)

Fortnight $2,075.00 (not including airfare)

Seminar $2,100.00 (not including airfare)

A financial agreement will be sent out requiring signature upon acceptance. Payments not received will result in the delegate being withdrawn from the travel program.

Signature of Parent/Guardian #1(Required)

Date of Signature of Parent/Guardian #1(Required)

Signature of Parent/Guardian #2

Date of Signature of Parent/Guardian #2

$30 Application Fee Paid via Zeffy:

Paid https://www.zeffy.com/en-US/donation-form/cisv-michigan-city-lakeshore-2026-summer-travel-progam-application-fee

I need assistance.

Apply for a Program

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Youth Delegate Application Form 2026

References

Parent/Guardian Information

CISV requires that both custodial parents/guardians sign this application form:

What are Parents'/Guardians' current volunteer activities?

CISV is run entirely by volunteers. Being an active volunteer in our chapter is taken into consideration in our selection process for delegates.

Child's Medical History

If your child is selected, a physician’s declaration of your child’s health and fitness for CISV participation will be required.

NATIONAL CODE OF CONDUCT AGREEMENT

Here are key elements of the CISV Child Behaviour Policy:

NATIONAL TRAVEL POLICY

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