CORDUSA Service Visit Application -Students

CORD SIRUVANI Summer 2024
– Student application form

Please read ALL instructions carefully before registering.

  • Each person must fill out the application on their own, NOT by their parent. The student will be disqualified if we learn later that a parent has filled out the application for them. No exceptions. Only those who are selected as chaperones can stay with the students during the service visit.
  • We require the participants to volunteer 40 hours with CORDUSA after they get back from the Service Visit.  We can guide on different local projects they can get involved with.  Please apply only if you are willing to do so.
  • Every field must be filled in before submitting. The email addresses you enter will be the only addresses to which we will send our further communications. Additional email addresses cannot be added later.
  • Once submitted, you will receive an email acknowledgment. Further information will be sent by email.  Please make sure to check your spam folder for acknowledgment emails.
  • Please download the “Release of Liability“(ROL) and “Frequently Asked Questions” (FAQ). Read the FAQ completely, fill in the ROL, and sign and scan it to a PDF (no JPGs) format to be uploaded with this application form.
  • An evaluation form by your Bala Vihar teacher must be filled out for your application to be complete. An email will be sent automatically to the address you provided for your Bala Vihar teacher. It is your responsibility to follow up with the Bala Vihar teacher, we will not send reminders requesting feedback.
  • A $250 non-refundable registration fee must be paid, through the link in the acknowledgment email.  Registration will not be considered valid until the $250 payment is made. Registered applicants will be evaluated and a list of participants will be notified by email later.
  • Once the attendee’s participation is confirmed, an additional payment of $1250 needs to be made within three (3) days of notification to guarantee your spot.
  • If you have financial difficulty, please reach out to us with the appropriate papers to get a reduced rate.

    Your First Name

    Your Middle Name

    Your Last Name

    Your email

    Cell Phone

    Gender

    Your DOB

    Please note that the application is open only for 10th, 11th, and 12th graders.

    Grade in Fall 2024

    Home Phone

    Address

    City State ZIP

    Which language other than English do you speak?

    Allergies

    List of Allergies

    Medications/Medical Conditions

    List of Medical Conditions & Medications

    The following information is regarding the participant's parents.

    Father's Name

    Father's Cell

    Father's Email

    Mother's Name

    Mother's Cell

    Mother's Email

    Adult Contact in India who can assume the participant’s responsibility in case of emergency/illness:
    The following information should be listed below :
    Last Name
    First Name
    Home Phone Number
    Cell Number
    Email
    Residential Address
    Relationship to the participant

    India Contact

    The following information is regarding the participant's current Chinmaya Mission activities.

    Your Chinmaya Mission Location

    Balavihar Teacher Name

    Balavihar Teacher Phone

    Balavihar Teacher Email

    Number of Years at this Chinmaya Mission Location

    The following information is regarding your previous volunteering experiences, both within and outside of Chinmaya Mission

    Please explain what type of volunteering activities have you done in the past and what you have gotten out of them

    Volunteering Activities

    What was your take-away?

    What do you hope to get out of this experience that you will not get out of another project in the US or elsewhere?

    Please explain briefly

    Some of the conditions you may/will encounter are: working in dust and mud, wearing Indian clothing, basic Indian food, lack of western toilets, lack of air-conditioning, encountering small pests like an occasional rat or spider, being silent during meals, follow instructions that may not make sense to you because it is different from how things are done in the US.

    How will you approach this situation?

    Please explain in simple words the link between this CORD USA Service Visit and your learnings from Chinmaya Mission.

    CM and CORDUSA

    Upload your completed and signed Release of Liability using the button below, in PDF format.

    I agree to do 40 hours of volunteering through CORDUSA after I return from this Service Visit