USSYP Application - Vicenza High School - DoDEA

DODEA
UNITED STATES SENATE YOUTH PROGRAM
APPLICATION FORM
(SY 2013-2014)
SUBMIT TO HIGH SCHOOL PRINCIPAL
1. Name: ____________________________________________________________________
(Last) (First) (Middle) (Nickname)
2. APO Mailing Address:
3. Email: 4. Home Phone:
5. School:
6. DoDDS Region:
Address:
District:
Country:
School Phone:
7. Date of Birth: ________________
Day / Month / Year
8. Of which state are your parents legal voting residents? ____________________
a. What is the legislative district number? ________________
b. Who is the Representative from the legislative district? ____________________________________
(To be considered the parents/guardian or applicant must have a legal voting residence)
9. Are you a ___junior or ___ senior? (check one)
10. Of the following elective student government or student council offices, check the one you now hold.
(if no office is checked, application cannot be considered)
____ Student Body President
____ Student Body Vice-President
____ Student Body Secretary
____ Student Body Treasurer
____ Student Council Representative
____ Class President
____ Class Vice-President
____ Class Secretary
____ Class Treasurer
11. Why did you run for office?
12. What is your scholastic rank in class?
13. What is your overall grade point average?
14. Indicate any school activities in which you have been involved in the last four years.

15. State your college plans:
16. State your future career goals:
17. List your hobbies:
18. Indicate any community activities in which you have been involved in the last four years.
19. If your parent(s) or guardian(s) is/are willing for you to go to Washington, D.C. for a week to attend
the United States Senate Youth Program under the conditions set forth in the rules and regulations,
please have them sign here:
(1)_____________________________________ (2)__________________________________
Signatures of Parents or Guardians
(1)_____________________________________ (2) __________________________________
Printed Names of Parents or Guardians
(1) _____________________________________ (2) __________________________________
Email addresses of Parents or Guardians
20. Please sign this application: _________________________________________________
Signature of Applicant

As part of the application, you must also include:
___ Principal’s certification of rank in class and grade point average.
___ Letter of recommendation from a current or former social studies teacher.
___ Letter of recommendation from school counselor or your class or student council sponsor.
___ Letter of recommendation from a school administrator (Principal, Deputy or Assistant Principal)
___ Completed tests