Personal Information
Which program are you applying for: YES FLEX PAX
Where did you hear about us?
Web search Local Newspaper Mail PAX Representative Teacher NY Times Other
If Local Newspapers Please list the local newspaper(s) in which you heard about us
Education Please list name of school(s), years completed, year graduated and degree awarded.
Employment History Please list employer, position, dates employed and reasons for leaving (list current or most recent job first).
Volunteer or Related Experience Please list organization, position and dates/length of service.
Experience with Youth Describe any experience you have had working with teens and families. Do you know teens? Do you enjoy working with them?
Have you ever served or are you currently serving as a representative for another high school exchange program? If yes, please explain.
Have you ever hosted a foreign student? If yes, when did you host, how many students did you host and from which country did they come?
Background Information Is there any history of child abuse, sexual abuse or emotional abuse in your family background? If yes, please explain. Is there anything in your background or current situation that would call into question your working with youth? If yes, please explain.
Is there anything in your background or current situation that would call into question your working with youth? If yes, please explain.
Area High Schools List those high schools in which you would like to enroll PAX students.
Recruiting Host Families Highlight any professional or volunteer experience that would be particularly useful in the coordinator position as you understand it. You might include sales experience, professional associations, community or religious activities.
Motivation Please tell us why you would like to become a PAX Community Coordinator. What would you like to contribute to the program? What benefits and rewards would you like to receive from your participation?
References Please provide two references who are not family members, one personal and one professional. FIRST REFERENCE Mr. Ms. Mrs. RELATIONSHIP YEARS KNOWN HOME TEL. WORK TEL. EMAIL SECOND REFERENCE Mr. Ms. Mrs. RELATIONSHIP YEARS KNOWN HOME TEL. WORK TEL. EMAIL
To expedite your inquiry, please call or e-mail PAX to confirm that your application was received.
