Experience. Summer College Tour. College Tour Includes: Hotel Room Ground Transportation Breakfast each day Lunch each day

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1 Experience Summer College Tour July 18 th, 2012 July 22 nd, 2012 College Tour Includes: Hotel Room Ground Transportation Breakfast each day Lunch each day Visits to: Wilberforce University (Oldest Private HBCU) Central State University Ohio State University Plus Tickets to each: NFL Hall of Fame Cleveland Indians Baseball Game Cedar Point Amusement Park (World Largest Park) Cost: Only $450.00

2 5 Star Youth Alliance, Inc Ohio Excursion Summer College Tour Wednesday July 18 th, 2012 thru Sunday July 22 nd, 2012 Cost $ per person Greetings, The 5 Star Youth Alliance, Inc will be conducting our Ohio Excursion Summer College Tour The tour will be conducted from July 18 th, 2012 thru Sunday July 22 nd, This tour provides students with a guided tour of 3 different Colleges and Universities in the state of Ohio. Two of the colleges are HBCU s. They are Wilberforce University - The Oldest HBCU in the Country and Central State University. The other college is The Ohio State University, which is the largest college campus in the country. Students on this tour will have a chance to compare and contrast the difference between a HBCU (Historically Black College or University) and a TWI (Traditionally White Institution). While both types of Universities have many different advantages for students who enroll, the students on this tour will be able to see which one is better for them. During the visits they will be able to tour academic, residential, athletic and administrative buildings to get a better understanding of what college life is all about. Our tours are a powerful educational experience that will motivate and encourage each student to improve their educational outcomes. Additionally, our tours open the doors of opportunity for each youth involved. The students will gain important insight and understanding regarding programs and majors at these colleges and universities that might help them determine their individual career paths. The Cost of this tour is $ and the deadline to register is Monday June 15 th, Registration includes a Completed Application and a $ Non-Refundable Deposit. Deposits are non-refundable as we use your deposit to secure advanced purchased items at a discounted rate and we cannot receive a refund either. Final payment of $ is due NO LATER THAN Friday July 6 th, There will also be a MANDATORY Parent/Student meeting on Monday July 16 th, 6:30pm. For out of town parents we have another option available for you. Please call for information related to that. Please us at if you are interested or have questions. You may also call The tours leaves out of Atlanta, Georgia on Wednesday July 18 th, 2012 at 7:00am and returns Sunday Night July 22 nd, At the conclusion of the tour we are sure each student will not only be excited and encouraged about attending college, but they will also be well prepared to make an informed decision about how to choose the college or university that best fits them.

3 COLLEGES & UNIVERSITIES VISITED PURPOSE OF THE COLLEGE TOUR Wilberforce University Central State University The Ohio State University 1. Take a guided tour of each campus. Students have a chance to walk through academic, residential, athletic and administrative buildings. 2. Students may meet and seek advice from counselors, faculty, and staff of their future major. Students may speak with coaches and directors of sports and clubs in which they want to participate (if notified in advance and time permits). 3. Talk with staff about financial aid options & scholarships and other types of financial assistance available to them. 4. Meet currently enrolled students and talk with them about campus life and personal experiences. One of the better ways for high schools students to learn about the college is to talk with students currently enrolled. 5. Meet with Admissions representatives to learn more about each school's admissions policies and deadlines. 6. The Tour also allows students opportunities to display their leadership, creative and original thoughts, independence, initiative, intellectual ability, academic achievement, and oral expression of ideas to officials at each campus they visit. FINAL ITENIARY WILL BE RELEASED ON July 16th AT THE MANDATORY PRE-TRIP ORIENTATION Cash, Money Orders, and Cashier Checks are accepted. No personal checks will be accepted. All applications and the initial $ deposit must be submitted no later than June 1 st, 2012 The pre-trip orientation for parents & students is scheduled for 7:00 pm Monday July 16th, 2012 This will be 4 physical and intellectual rigorous days of exploration and enlightenment. Please come prepared to take notes and ask questions. Comfortable clothing walking shoes are highly recommended. In addition to the colleges & universities listed above students will also visit the following attractions: The NFL Hall of Fame Cleveland Indians Professional Baseball game Cedar Point Amusement Park (Largest Amusement Park in the WORLD!)

4 OHIO EXCURSION SUMMER COLLEGE TOUR INFORMATION SHEET Instructions: Each Applicant must submit a completed application in its entirety (see check list). Failure to comply may result in a cancellation or delay in processing your application materials. Only signed original documents will be accepted (i.e. No electronic versions, faxes, or copies, etc.) Application Packet - CHECK LIST 1) Each student must submit a COMPLETED application form. 2) Each student must submit a current facial photograph; No electronic photos will be accepted. 3) Each student must submit a photocopy of their current health insurance card. 4) Each student must submit a signed liability form. 5) A $250 non-refundable deposit is required to reserve a seat on the tour and must be accompanied with all completed application materials. Make your Cashier s Check or Money order payable to: 5 Star Youth Alliance Mail to: P. O. Box Atlanta, GA We also accept payment via credit card or PayPal Invoicing WE DO NOT ACCEPT PERSONAL CHECK!!!! Mail the application, deposit, photograph, & copy of healthcare card to the address shown above Full payment is due Friday July 6 th, Cancellation from the tour on your part forfeits all payments Ohio Excursion College Tour Payment Schedule To register By June 15 th $250 Final Payment July 6 th $200 Total Due $450 ******Please note there must be a minimum of 21 registered students in order to complete the tour as is. If the number of students needed to register is not met, the tour will be canceled and A FULL REFUND will be issued.***** You are More than welcome to pay for the trip in full

5 5 Star Youth Alliance, Incorporated College Tour Application Participants Full Name: Gender: Age: Student Address: Student Cell Phone #: Grade Level: Academic Interest: Social Interest: Career Goals: Parent/Guardian(s) Name: Parent/Guardian(s) Telephone (Home) (Work) Cell: Street Address: State: Zip: I/We understand our child must abide by the rules of good conduct and the explicit rules of the tour coordinator and chaperons. I /we are also aware that any serious acts of misbehavior on my/our child s part may result in their dismissal from the tour group and returned home at my/our expense. I understand that an initial NON-REFUNDABLE deposit of $ will be due by June 15 th, This deposit will reserve your space and guarantee your trip T-shirt. I understand that the final payment of $ will be due by July 6 th, 2012 to finalize your space on the bus. PLEASE CHOOSE T-SHIRT SIZE: Med. Large XL 2XL. 3XL As a condition of my child s participation on the tour, I agree to attend the pre-trip orientation to be held Monday July 16th, 2012 at 7:00 pm (All participants are required to attend). I/We hereby give permission for my child to participate in the activities associated with the 5 Star Youth Alliance, Inc s Ohio Excursion College Tour on July 18 th, 2012 through July 22 nd, I/we are aware there are risks inherent in traveling and agree not to hold 5 Star Youth Alliance Inc. Responsible for unforeseen incidents.

6 I/We understand that the 5 Star Youth Alliance, Inc. will do its utmost best to ensure the safety of each child that travels with our organization. Therefore I/we will not hold The 5 Star Youth Alliance, Inc. or any of its employees, directors, officers or representatives, responsible for my child s well-being due to unforeseeable incidents while participating in 5 Star Youth Alliance activities. Activities will include the college tour, traveling to events (destinations) and from activities, events and destinations. In the event of any unforeseen circumstances, that may require immediate medical attention, I authorize a 5 Star Youth Alliance, Inc. employee or representative to obtain any medical care needed for my/our child at my/our expense. Medical Insurance Company: Policy # Group Code/Number Member # Describe any medical conditions: Emergency Contact: Phone: Student Signature: Date: Parent(s)/Guardian(s) Signature: Date: Emergency Contact Information 1) First Name: Last Name: Home Phone: Cell Phone: Address: Who is this contact: 2) First Name: Last Name: Home Phone: Cell Phone: Address: Who is this contact:

7 5 Star Youth Alliance Incorporated Liability Waiver I, Parent (Print Name) voluntarily agree to allow my child ( Print Student Name) to participate in the college tour/excursion sponsored by 5 Star Youth Alliance, Inc. I (Student Name) also agree to abide by the rules and regulations set by 5 Star Youth Alliance, Inc. and its designated representatives for the health, welfare, and security of all tour participants. I agree to hold harmless 5 Star Youth Alliance, Inc from any claims that occur as a result of participation in the tour. I (Student) voluntarily agree to all of the following terms and conditions, which shall be binding between 5 Star Youth Alliance, Inc and the parent or guardian. As the parent or guardian, I understand that my child is expected to do everything they can to benefit from this experience and be a productive member of the group. Each child must promise to be on their best behavior while on this trip. Initial Parent Student I/WE, the parent(s)/guardian(s) have also read the stated rules and regulations under the Agreed Upon Rules for College Tour. I/We also understand that if my/our child does not adhere to the rules and/or directions of the supervising chaperone, I/we will accept all responsibility and costs incurred associated with the immediate return home of my/our child. Initial I/We hereby give permission for my/our child to participate in the activities associated with the 5 Star Youth Alliance College Tour. As parent(s) or guardians, we are aware of the risk inherent in travel and this college tour, and we will assume full responsibility for my/our child s well-being while he/she is on this tour. Therefore, parent(s) or guardians will not hold 5 Star Youth Alliance, Inc. College Tour, or any of its faculty, staff or administration, responsible for my/our child s well-being while participating in the activities of the 5 Star Youth Alliance and in particular this college tour, while traveling to and from these activities. Parent(s) and guardians agree that 5 Star Youth Alliance, it s faculty, staff and administration and tour chaperones shall not be liable for any injury, loss, or damage to my/our child s personal property, direct or consequential, arising out of the activities of the college tour. In the event of any unforeseen circumstances requiring immediate medical attention, I/we authorize a 5 Star Youth Alliance College Tour staff, faculty or administrator to obtain medical care for my/our child at my/our expense. Initial

8 The 5 Star Youth Alliance Ohio Excursion College Tour was created for the purpose of exposing students to the rich traditions of Colleges and Universities of higher learning through campus tours and cultural excursions. 5 Star Youth Alliance performs a variety of services in relation to these tours. 5 Star Youth Alliance as the prime stakeholder shall be responsible for arranging accommodations, travel services, meals, events, activities, etc. 5 Star Youth Alliance cannot be responsible, however, for unforeseen occurrences such as an independent company s failure to honor a confirmed reservation or to provide services it has been contracted to perform. As the parent(s) or guardian, I release 5 Star Youth Alliance. (its employees, agents, colleges, universities and school board) from any claims arising from the failure of any transportation company, hotel, restaurant, or other supplier of tour services, arrangements, or accommodations, to effectively execute arrangements set forth in any tour itinerary. Initial I acknowledge that 5 Star Youth Alliance cannot be liable for events outside its powers, such as (without limitation to) strikes, delays, acts of God, acts of nature, war, terrorism, or governmental restrictions; or for the actions or errors of any person or entity not within its control, such as (without limitation to) transportation companies, hotels, restaurants, and other suppliers of tour services, arrangements, or accommodations. I release 5 Star Youth Alliance (Its employees, agents, colleges, and college administrators) from any claims stemming from such events, actions, or errors. If I wish to obtain travel insurance, baggage protection insurance, or other insurance coverage, it is my responsibility to obtain this on my own. Initial As the parent(s) or guardians, we also acknowledge that we will not hold 5 Star Youth Alliance, its staff, volunteers, chaperones, or administrators responsible if my child decided to break the rules and regulations and finds him/herself in any trouble what so ever. Initial Student Signature Parent(s)/ Guardian(s) Name(s) Address Parent Home Number Parent Cell Number Parent Address: Student Address:

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