2015 U-Voice STUDENT APPLICATION FORM MISSION TRAINING WORKSHOP U-Voice Summer Mission Training Workshop Application

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1 2015 U-Voice Summer Mission Training Workshop Application

2 Thank you for your consideration and desire to participate on an Operation Smile medical mission as part of the U-Voice Student Team! Please read the following information carefully before applying. ROLE The primary role of a U-Voice Student is to tell the story of an Operation Smile Medical Mission. The U- Voice student will capture stories of our patients, our volunteers and of the unique components of the mission. They will then tell these stories through writing, photos and video. The U-Voice student will be responsible for, but not limited to maintaining a daily mission blog, writing a patient story, writing a volunteer story, writing a unique mission story, and creating a video encapsulating their experience. Upon returning from the medical mission the U-Voice student will also be required to present their video to at least 5 different audiences. We also ask that they work to have their stories published in their university and local newspapers. REQUIREMENT Applicants must be a university student, an active member of an Operation Smile Student Club, and have been involved for at least one year. Once accepted to the U-Voice Program, students are required attend a Mission Training Workshop that will take place at Chapman University in Orange County, California from July 17-20, ASSOCIATED COST Before applying, please be aware of the potential costs associated with the U-Voice Program. We encourage students to find local sponsors and donors to help defray the cost. U-Voice Fee (to help offset the cost of mission flights and hotel) $1500 (due a month before the mission) Mission Training Workshop $275 (due a month before the training) Transportation to Mission Training Workshop $ varies Immunizations $0-300 Passport/Visa Fee.$0-200 Dinners/Incidentals during the Mission $ HEALTH/SAFETY/TRAVEL Mission sites are typically in remote areas with limited resources. Those with health concerns, and/or specific dietary needs should be cautious in applying. A team doctor is available on every medical mission. However, we require all mission participants to care for their recurring medical treatments without supervision. All medications, injections or other treatments must be monitored and administered solely by the participant. Medication requiring refrigeration could be problematic. Please understand we may not be able to control the contents of food products during travel or during the medical mission. Should you have strict dietary needs, you are ultimately responsible for inspecting all food for ingredients related to a specific dietary requirement.

3 As with any international travel, please be aware of inherent risks during travel. For the safety of the student participants, they are expected to strictly abide by a code of conduct; failure to comply by the code is grounds for dismissal and a prompt return home at personal expense. Students selected for the U-Voice Program will need a valid passport. Operation Smile staff will assist the U-Voice students with obtaining a visa if the country they are traveling to requires one. AMBASSADORS OF OPERATION SMILE/CODE OF CONDUCT By taking the next step in your involvement with Operation Smile, you acknowledge that you represent Operation Smile as a student ambassador in your school, local community and abroad on a mission. Operation Smile Student Programs expects that participants represent themselves and the organization in a way that brings positive light to both. U-Voice participants, regardless of age, represent Operation Smile Student Programs. By applying to this program, you are agreeing to abide by the rules set forth by the organization. Operation Smile Student Programs has a zero tolerance policy for drinking alcoholic beverages and co-habitation on missions. Most U-Voice participants will be assigned with a student team with two high school students (health educators) and a student sponsor (adult chaperone). The purpose of the adult chaperone is solely for the safety and security of the student team. U-Voice participants will respect and follow the rules set forth by Operation Smile Student Programs and the student sponsor. MISSION PLACEMENT Finally, due to a limited number of medical missions and available positions, not all applicants will be accepted to Mission Training Workshop. Additionally, mission sites, dates, and availability are subject to change without notice. Flexibility as to mission dates and assignments is expected. Attendance at MTW does not guarantee that a student will be placed on a mission. Participants can expect to miss an extended period of school, activities, and/or work, including exams, sporting events, theater, etc. Therefore it is imperative you have school administrative support BEFORE you submit your application. U-Voice training is good for one year. If a participant chooses a mission that is then moved in dates and cannot commit to another available mission date, training may expire without being placed on a mission. Accepted applicants may or may not receive mission assignments at the Mission Training Workshop.

4 Application Check List Part 1 Applicant Information Part 2 Acknowledgement of Terms and Conditions Part 3 Application Guidelines Part 4 - One Recommendation Mail the completed U-Voice MTW Application, attachments and letters of recommendation to: Operation Smile Attn: Student Programs/U-Voice Student Application 3641 Faculty Blvd, Virginia Beach, VA Applications must be postmarked by March 15, Incomplete applications will not be considered. Kindly use a paperclip for your application and please do not staple. If you have any questions after going through the entire application, feel free to us at student.programs@operationsmile.org.

5 Part 1 Applicant Information Applicant Information (please print clearly or type) Last Name: First Name: Date of Birth: Your Home Phone: Your Mobile Phone: Address: City: State/Province: Zip: Country: Year of Graduation: Languages Spoken: Do you have a current passport? Yes No Health Concerns (i.e. Asthma, allergies, etc.) Note: On a separate sheet, please provide additional information regarding any conditions you noted above or other conditions that we should be aware, including treatment descriptions. Please note, this information is VERY important; however it will not impact your acceptance to training. Applicant s School Information (please print or type) School Name: School Address: Applicant s Student Club Advisor Information (please print or type) Last Name: First Name: Office Phone: Student Club Leadership (please print or type) Office(s) Held: Office(s) Held: Office(s) Held: Office(s) Held: School Year: - School Year: - School Year: - School Year: - Location of ISLC(s) Attended: Year: Attended: Year:

6 Part 2 Acknowledge of Terms and Conditions I,, have read and understand the Terms of U-Voice MTW (Student Name) Application. I recognize that submission of this application does not guarantee acceptance. I recognize and accept that to participate on a medical mission may require that I miss an extended period of school, including exams, athletics, theater, etc. If selected, I agree to prepare and present my mission experience to a minimum of five different audiences. My purpose for presenting is to gain invaluable experience in public speaking and to raise awareness as an ambassador for Operation Smile. I also agree to submit an essay and photo describing my experiences to Operation Smile for potential use in media publications. I understand that I may not receive a mission assignment at the Mission Training Workshop, but at a later date. I agree to the Code of Conduct in representing Operation Smile Student Programs in a positive light. While at training and on my mission, I will be adhere to the rules of not consuming alcohol, no cohabitation and respecting the decisions of my student sponsor. Signature of Applicant Date PROGRAM REQUIREMENTS If accepted to the U-Voice Program, you will be required to attend U-Voice Mission Training Workshop in California from July 17-20, While at the mission the student will be collecting stories and capturing photos and videos to complete their assignments. The U-Voice student will be asked to use their own camera and laptop during the mission. A daily mission blog will be due at the end of each day while on the mission. The stories, photos, video will be due two weeks from the last day of the medical mission. Once these items are submitted and approved by Operation Smile the student will have another month to get their stories published in their university and local newspaper and to present their video to 5 different audiences. Sustained communication with Operation Smile s headquarters is expected of all U-Voice Students. I will be able to fulfill the U-Voice requirements as stated above. Signature Date

7 Please attach the following to your application: Part 3 Application Guidelines A. Written Essay that answers the following questions: 1) What have you done to demonstrate your commitment to Operation Smile? 2) Why do you want to participate in the U-Voice Program? 3) What skills and qualities do you possess that will make you a good U-Voice journalist? 4) From a long term perspective, how would your participation on a medical mission benefit both Operation Smile and yourself? B. Video Essay For this part of the application, we ask you to creatively show us who you are by making a short video documentary about yourself! This is NOT a video interview or a photo slideshow. This enables us to peek into your personality and will give you the opportunity to showcase your storytelling and journalism skills. The video must be a minimum of 2 minutes and a maximum of 4 minutes. Be yourself, be creative and have fun! There are 2 ways to submit your video essay. Pick one that works best for you. 1. Send in a DVD copy of your video with your application. 2. Post your video to YouTube and provide us your account username here:. C. Writing Sample & Photo Samples Pease provide us one sample of your best writing and several (3-6) of your best photos. The writing sample can be a paper you have written for school, a link to your blog, a page out of your journal, etc. Just impress us with your writing skills! For your photo sample we would prefer to see photos of people as opposed to landscape, as our U-Voice journalists will be taking photos of patients and volunteers. We want to see how you can capture emotion with a camera. D. One letter of recommendation to be filled out by a non-relative. E. A current transcript copy (unofficial).

8 Part 4 Letter of Recommendation Please submit one letter of recommendation. Note that letters cannot be written by Operation Smile employees. Letters should be returned to you in a sealed envelope that is signed across the back. We suggest you request the letters early to allow the Recommender time to return them to you prior to the submission deadline. Recommendation forms are at the end of this application.

9 RECOMMENDATION FORM To the Student Applicant: Fill in the information below and give it to an adult, non-family member, who knows you and your relationship with Operation Smile. (Please note, letters cannot be written by Operation Smile employees). With each form, provide the recommender with a self addressed, stamped envelope. Recommenders should seal the envelope and sign their signature across the seal before returning it to you. Submit the recommendation letter with your completed application. Applicant s Name: School Name: Year of Graduation: To the Recommender: Return your letter and this form in the stamped, addressed envelope provided by the student. Seal & sign across the envelope flap. Operation Smile finds candid evaluations helpful in choosing from many highly qualified Mission Training applicants. We are primarily interested in the contributions and personal efforts this student has made in service to others, leadership, and teamwork. Please include anything you feel is important about this candidate s qualifications to be a member of an Operation Smile Medical Mission. We are grateful for your assistance and request that you sign below. Recommender s Name: Employment/School Name: Position: Phone: Signature Date Evaluation In a letter, please detail your observations of this student, for the time you have known him/her, including a description of Operation Smile involvement and personal characteristics. Community service, team activities, leadership roles, potential, maturity, independence, initiative, leadership, special talents, concern for others, and reaction to setbacks are valued as well. Please use examples wherever possible. We welcome all information that will set this student apart. Confidentiality We value your comments. This form and your letter will be kept in the applicant s file, should they be accepted for Mission Training. Unless required by state law, Operation Smile will not provide applicants access to records, or to those students denied acceptance or those students who decline their acceptance. Operation Smile is committed to administer all policies and activities without discrimination on the basis of race, color, religion, national or ethnic origin, handicap, or gender.