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Student Exchange Application

This includes spending 3 weeks with a host family in Gilbert, Arizona and hosting a USA student for 3 weeks in Antrim and Newtownabbey.

To be eligible for the programme you must reside in the Borough of Antrim and Newtownabbey and be aged 16/17 (Year 13).

The closing date for entries is Monday 4 February 2019.




Country of birth:

Please note all medical conditions must be declared to comply with travel insurance requirements

Student: 1. In the event of illness, you must do as your host family advises. If emergency treatment is required or you become seriously ill, your host family will advise your parents. 2. Exchangees are not permitted to drive any motorized vehicle. 3. While staying with your host family, you will be expected to participate in family life, which may include performing routine household tasks or chores. Be alert to the fact that your host family will have “family rules” by which you are expected to abide and that your host family may have a different approach to young people than your own family does. 4. During the exchange, you may travel with your host family or participate in other organised trips. You may not travel alone to distant points unless you have the prior written permission of your own parents/guardians and your host family. Trips should be planned well in advance with a definite place of residence. A copy of your itinerary should be left with your own family and your host family. Hitchhiking is not allowed.
5. The drinking of alcohol is not allowed during the exchange. Drugs, other than medication prescribed by a doctor, are forbidden. I understand that if chosen, I must abide by all rules of responsible conduct expected of me while living with a host family. I understand that my failure to do so will result in me being sent home at my parents/guardians expense.
Parents/Guardian My son/daughter has my permission to apply for and participate in the Sister Cities Exchange Programme with Gilbert, USA. I (we) have read and understand the attached sheet explaining the programme and our responsibilities. As the applicant’s parent/guardian, and in the event that my son/daughter is selected for the student exchange programme, I hereby agree to authorise the host family in the above-mentioned city to act for me in an emergency or accident or illness. I understand that my child’s failure to abide by all rules of responsible conduct will result in him/her being sent home. I understand that in such an event we are responsible for any additional expense incurred.
Access Northern Ireland As this programme will involve substantial access to children, it is our policy to ask for an Enhanced Disclosure check to be carried out by Access NI. Access NI enables organisations in Northern Ireland to make more informed decisions by providing criminal history information about anyone seeking paid or unpaid work in certain defined areas, such as working with children or vulnerable adults. Access NI is part of central government and operates under the provisions of Part V of the Police Act 1997. An Enhanced Disclosure contains all of the information in the Standard Disclosure including spent and unspent convictions and cautions plus other relevant information held in police records. It also clearly indicates whether the applicant is on the ISAs Children’s list or Vulnerable Adults list and therefore is barred from working with those groups. Relevant information in police records can include information about attempted prosecutions that were unsuccessful or behaviour that might be indicative of criminal activity. Both the Council and the Applicant will receive copies of the Disclosure Certificate This check will also be carried out for any persons who are aged 16 or over living in the household. Any information, which we receive, will be treated confidentially, and will be discussed with you before we make a final decision. We will ask for your check only if your child is selected to participate in this programme. However, you must tell us now if you have ever been convicted of a criminal offence, or cautioned by the police, or bound over. You must include all offences, even minor matters such as motoring offences, and ‘spent’ convictions, that are things that happened a long time ago. You must not leave anything out. IF SUCCESSFUL, EACH PARENT/GUARDIAN AND RESIDENT OVER THE AGE OF 16 MUST COMPLETE AN INDIVIDUAL FORM I understand that Access NI Enhanced checks must be carried out before my son/daughter can participate on this programme and I consent to the check.
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