THI Application Form

8/20/2019 THI Application Form

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Fellowship for a New EconomyInvesting in the Future of Greece

Application checklist:

c Completed application

c Copy of valid passport

c Proof of English ability

c Proof of academic status (current students only)

c College & Graduate study transcript and diploma (if applicable)

c Current CV

c Privacy, HIPAA, and confidentiality release (optional)


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In partnership with CIEE.

thehellenicinitiative.org | ciee.org 2 Last updated 2014-04

Program Application

Thank you for your interest in the Fellowship for a New Economy, an innovative program to build new economic foundations in

Greece. The Fellowship promotes sustainable growth by investing in a new generation of Greek business leaders who can buildstrong companies able to compete in an increasingly global economy.

Fellows will represent a number of sectors with long-term growth potential, including but not limited to tourism & hospitality,food production, energy, information technology, manufacturing and pharmaceuticals. Through year-long placements in leadingUS businesses, Fellows will develop new skills, mindsets and capabilities to build these sectors back in Greece. Participating UScompanies include IBM, Hostess Brands, Coca Cola, Pabst, Dow Chemicals, Huffington Post, Libra Group and many others.

In addition, Fellows will participate in a structured professional development program to reinforce on-the-job experience,exposing participants to leading thinking across economic sectors, business functions and international relations throughmultiple weekend-long seminars throughout the year.

The Fellowship is open to residents of Greece with academic or professional experience in the growth sectors listed above.Accepted Fellows will receive a stipend ($35,000 - $45,000) and assistance with travel expenses. Health insurance is provided.Applicants must commit to return to Greece at the completion of the program or the stipend must be reimbursed. This commit-

ment reinforces the fundamental objective of this program to build new foundations for the Greek economy.

Applicants will be assessed on their professional and academic records, English language skills, commitment to communityservice, and vision for economic renewal in Greece. The program comprises two tracks:

1) Intern Fellowship – Enrolled graduate student or graduate of a graduate degree program no more than six months priorto date of application.

2) Trainee Fellowship – Graduate degree with at least one year of relevant work experience OR at least an undergraduatedegree and five years relevant work experience. For candidates with at least five years relevant work experience thedegree does not need to be related to their current profession.

As you prepare to submit your application, please consult the Application Checklist on the front cover. Use the checklist togather all of the documents required to complete your application. All application documents must be submitted at the sametime by the stated deadline of May 7, 2014.

Once you submit your application and supporting documents, you will receive a link from Korn/Ferry International to completean online simulation. This simulation is based on a “real life” work experience and is designed to better understand yourleadership style, how you make decisions and how you interact with and influence colleagues. All applicants will receive adetailed summary of their strengths and development opportunities, regardless of whether they are selected for an interview.The simulation takes about 45 minutes to complete. It is a required part of the application process and we cannot evaluateyour candidacy without it.

If you have questions while you are working on your application, please contact us at [email protected].

Thank you again for your interest in the Fellowship for a New Economy.

Sincerely,

Andrew N. LiverisChairman


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Program Application

Application Information

Application Type

F Intern Fellowship – Enrolled graduate student or graduate of a graduate degree program no more than six months prior to dateof application.

F Trainee Fellowship – Graduate degree with at least one year of relevant work experience OR at least an undergraduate degreeand five years relevant work experience. For candidates with at least five years relevant work experience the degree does not neeto be related to their current profession.

Personal Details (Please fill these in as they appear on your passport)

Last Name: First Name: Middle Initial:

Gender: Date of Birth (dd/mm/yyyy):

City of Birth: Country of Birth:

Country of Citizenship: Country of Legal Permanent Residence:Passport Number: Passport Expiration Date (dd/mm/yyyy):

Contact Information

Email (mandatory):

Current Address

Street:

Postal Code: City: Country:

Home Phone (country code/city code/number):

Mobile/Cellular Phone (country code/city code/number):

Permanent Address F (check if same as above)Street:

Postal Code: City: Country:

Emergency Contact

Last Name: First Name:

Relationship to Participant:

Email:

Home Phone (country code/city code/number):

Mobile/Cellular Phone (country code/city code/number):


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Program Application

Previous Visas

Have you ever received a J-1 Visa to enter the US? c Yes c No If yes, how many?:

(If you answer yes to this question, please complete the following section. If you have received more than 2 previous J-1 Visas, please use an additionalsheet of paper to provide the same information as below for each additional visa.)

1) Type of Program: J-1 Sponsor:

c Summer Work/Travel Organization (employer):

c Au Pair or EduCare City:

c Camp Counselor State:

c Trainee Dates of DS-2019 (dd/mm/yyyy):

c Intern

c Other, please specify:

2) Type of Program: J-1 Sponsor:

c Summer Work/Travel Organization (employer):

c Au Pair or EduCare City:

c Camp Counselor State:

c Trainee Dates of DS-2019 (dd/mm/yyyy):

c Intern

c Other, please specify:

Other Visa Information

If you answer yes to any of the below questions, please submit all relevant documentation along with this application.Have you ever been denied entry into the US? c Yes c No

Have you ever applied for a visa to immigrate permanently to the US? c Yes c No

Have you ever been arrested and convicted of a crime in your home country? c Yes c No

Have you ever been arrested and convicted of a crime in the US? c Yes c No

Have you ever been refused a visa by a US Embassy or Consulate? c Yes c No


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Program Application

Proof of English Ability

Applicant must possess sufficient English language proficiency to successfully complete the internship/training program as outlined on

form DS – 7002 Please choose one of the following:

c Native English speaker

c Attach a copy of an official score that you received on a standardized English exam (TOEFL, TOEIC, etc.)

Test:Score:

c Attach a copy of your grades/marks, translated to English, for English language classes taken as part of your post-secondaryeducation. (At least 2 courses must have been taken in which high marks were received.)

c Attach a letter from your English professor/docent certifying your English proficiency. See Appendix 1.

Intern Track Applicants (Select one option as applicable)

c I certify that I am enrolled in a graduate program. A copy of my transcript is attached. My anticipated graduation date isspecified below.

c I certify that I have graduated from a graduate degree program no more than six months prior to the date of application. (Forexample, applicants applying on April 1, 2014 must have graduated between November 1, 2013 and March 31, 2014) Copies of my transcriptand diploma are attached.

Date of Graduation (mm/dd/yyyy): Degree Type: Field of Study:

Trainee Track Applicants (Select one option as applicable)

c I certify that I hold a graduate degree in my field of training and I have at least one year of relevant experience after graduation.

Copies of my diploma, transcript and CV are attached.Date of Graduation (mm/dd/yyyy): Degree Type: Field of Study:

c I certify that I have at least an undergraduate degree and five years relevant work experience. (For candidates with at least five yearsrelevant work experience the degree does not need to be related to their current profession) Copies of my diploma, transcript and CVare attached.


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Program Application

Proof of Academic Status and Academic Endorsement

This page must be completed for current students applying for Intern Fellowship roles only. Applicants for Trainee Fellowship roles can

skip this section.

Enrolled Students

If you are an enrolled student applying to the Intern Fellowship, you must have this section completed by an Academic Advisor,Placement Officer Counselor, or Department Head from your academic institution. If your academic Institution will not sign this form,you must attach a letter on official institution letterhead verifying the same Information. The person completing this form should beinstructed to complete it in English and not to use abbreviations.

Name of Academic Advisor:

Title:

Telephone: Email:

Name of Academic Institution:

Website:

I certify that , the applicant for an Internship program in the U.S., is currentlenrolled full-time at my institution.

Years of Study Completed at the Time of Departure:

Anticipated Graduation Date (dd/mm/yyyy):

Major/Field of Study:

Name of Diploma/Degree:

Will this Internship program be evaluated by the academic institution? c Yes c No

How will your academic institution evaluate the Internship?

c Written/oral report

c On-site evaluation by an official from the school

c Other, specify:

How does your institution view this program?

c It is required for the applicant to graduate, OR

c It is an integral part of the curriculum, OR

c It is optional but supported by our academic Institution, OR

c Applicant will graduate prior to starting program

I certify that the applicant may interrupt his/her studies for a maximum of months to complete this Internship program.

Signature: Academic Emblem or Seal:

Date:


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Program Application

Personal Statement (250 words maximum for each question)

The Fellowship for a New Economy is designed to build the capabilities required to promote long term development of the Greek

economy. For the following questions please focus on a sector of the economy that you believe has potential for real growth over a 20year horizon (e.g., tourism and hospitality, energy and clean technology, food export, information and communications technology, other).

1. What are the most important near term and medium term opportunities for growth in your sector?

2. What are your own career ambitions within this sector? What legacy do you want to build?

3. To succeed as a business leader in this sector, what capabilities must you develop and how will the Fellowship help you build them?

4. What capabilities and achievements position you for success as a Fellow?


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Program Application

Applicant Resume

Name:

Education (Please list in order starting with the most recent)

University/Academic Institution:

Major Field of Study:

Type of Degree/Certificate:

Date of Enrollment (mm/dd/yyyy):

Date of Requirements for Degree Completed, or Anticipated Date (mm/dd/yyyy):

Diploma Issuance Date (mm/dd/yyyy): Diploma Issuance Country:

University/Academic Institution:

Major Field of Study:Type of Degree/Certificate:

Date of Enrollment (mm/dd/yyyy):

Date of Requirements for Degree Completed, or Anticipated Date (mm/dd/yyyy):

Diploma Issuance Date (mm/dd/yyyy): Diploma Issuance Country:


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Program Application

Work Experience (Please list in order starting with the most recent. If you do not have any work experience, pleasecomplete the box at the bottom of the next page)

Company Name:Job Type: c Internship c Apprenticeship c Volunteer c Part-Time c Full-Time Job

Position Title: Country:

Dates: From (dd/mm/yyyy): To (dd/mm/yyyy):

Number of Hours Per Week:

Job Responsibilities:

Company Name:

Job Type: c Internship c Apprenticeship c Volunteer c Part-Time c Full-Time Job





Company Name:







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Program Application

Work Experience (Continued)

Company Name:






Company Name:Job Type: c Internship c Apprenticeship c Volunteer c Part-Time c Full-Time Job





If you do not have any work experience, please describe below the knowledge and skills you have acquired through your academicstudies that are particularly relevant to your proposed training. Include specific course names where appropriate.


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Program Application

Terms and Conditions/Participant Declaration

The following section outlines the terms and conditions of the Applicant’s participation in the THI/CIEE Fellowship Program. You are

required to read carefully the following Information, and confirm that you have read, understand and agree with these terms bysigning and dating the last page. If you fail to sign or date this section, THI/CIEE will be unable to process your application.

SECTION I. Applicant Responsibilities

1. The Applicant agrees that all the information provided inthe application is true to the best of his/her knowledge, andacknowledges that any false or misleading information maylead to the rejection of the application or, if discovered later,to immediate dismissal from the program.

2. The Applicant confirms that the recommendation letters sub-mitted by the Applicant were written by the recommender or

referee, not by the Applicant and simply signed by the recom-mender or referee.

3. The Applicant confirms that the Applicant’s personal statementrepresents the Applicant’s original work and thoughts and hasnot been copied from any other source. Plagiarism of any kindwill lead to automatic disqualification or, if discovered later,dismissal from the program.

4. The Applicant is responsible for considering his/her personalhealth and safety needs when applying for and participating inthe program. If the Applicant suffers from any health or othercondition that would create a risk for him or her or others whileabroad, he/she shouldnot apply.

5. THI/CIEE reserves the right to refuse sponsorship to any Ap-plicant that THI/CIEE deems does not meet program eligibilityrequirements or any Applicant that THI /CIEE does not deemappropriate to accept in the general interests of the program

6. The Hellenic Initiative is a competitive award and thereforereserves the right to select a limited number of Applicants toreceive the award, who the selection committee decides bestembody the values, goals, and objectives of THI.

7. The Applicant is responsible for submitting all requested docu-mentation (including a passport) to the THI/CIEE Representa-tive in a timely fashion for visa processing. THI/CIEE cannot beheld responsible for any additional costs incurred (includingthe cost of rebooking a flight) by the Applicant due to delaysin submitting documentation or delays by the U.S. Embassy in

issuing a visa. Moreover, THI/CIEE advises the Applicant not tobook a flight until he/she has secured the visa, since THI/CIEEcannot be held responsible for the costs of rebooking or can-celling a flight due to delays in processing or visa rejections.

8. The Applicant must pay the local visa fee to the U.S. Embassy.The Applicant is also responsible for any additional fees thatmight apply at the U.S. Embassy or Consulate in the countrywhere he/she is applying for the visa.

9. The Applicant will be subject to English language screeningand will need to complete an interview in order to participatin the program.

10. The Applicant must supply THI/CIEE with the name andcontact details for an emergency contact, to be contacted inthe case of emergency. These details must be included on thapplication form.

11. The Applicant must not submit a program application with thintent to train in the U.S. in prohibited positions, including as

an au pair, childcare giver, teacher, teaching assistant, campcounselor, in private households, as a ship or aircraft crewmember, or as medical staff having patient contact. More infmation on prohibited positions can be found on the programwebsite at www.THI/CIEE.org/intern.

12. If the Applicant has recently held a J-1 Exchange Visitor Visafor the U.S., he/she may have to remain in his/her homecountry for a period of 90 days before beginning a new J-1program at the same Host Organization.

13. THI/CIEE may issue a DS-2019 form if the Applicant meets arelevant program requirements, but has no control over thedecision of the U.S. Embassy or Consulate in the Applicant’scountry of residence to issue a J-1 Visa.

SECTION II.General Program Participant Responsibilities

14. The Participant is responsible for reading and carefully con-sidering all materials made available to him or her that relateto safety, health, legal, environmental, political, cultural andreligious customs and conditions in the U.S. The Participantmust take full responsibility in the event that laws, regulationor customs are broken, regardless of his/her actual knowledgof these laws, regulations, or customs.

15. The Participant acknowledges that it is solely the Participantresponsibility to abide by all THI and CIEE program rules andU.S. laws and regulations with respect to the Participant’s visstatus. The Participant agrees that any injury or damage thatthe Participant may incur by not leaving the U.S. in accordanwith the stipulations of the Participant’s visa or applicablestipulations of THI and CIEE program rules and U.S. laws andregulations shall be the sole responsibility of the Participantand not the responsibility of either THI or CIEE.

16. In addition to reviewing all program materials, the Participanis required to complete a THI/CIEE orientation.

17. Passports must be valid for at least 6 months beyond theanticipated date of departure from the U.S. Individuals who


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Program Application

have recently held a J-1 visa for the U.S. must remain in theirhome country for a minimum of 90 days before THI/CIEEcan issue a DS-2019 form. The Participant is responsible for

submitting all requested documentation (including passportcopy) to THI/CIEE by the deadline stated in the Internshipaward acceptance letter for visa processing. THI/CIEE cannotbe held responsible for any additional costs incurred (includingthe cost of rebooking a flight) due to delays by the Participantin submitting documentation or delays by the U.S. Embassyin issuing a visa. It is the responsibility of the Participant toexercise due care once in possession of the legal documenta-tion (DS-2019) and visa. The cost of replacing these items dueto lack of care must be borne by the Participant.

18. The Participant will be issued a DS-2019 form, provided allrelevant program requirements are met, but THI /CIEE cannotguarantee that the U.S. Embassy or Consulate will issue a J-1visa.

19. The visa application process may take as long as several weeksto complete. Since the Participant must surrender his/her pass-port to the Embassy during the visa application process, theParticipant must be sure not to arrange any travel for which apassport is necessary during the visa application period.

20. This program is subject to U.S. government approval andchange without notice. Please also note that the U.S. govern-ment has implemented an immigration tracking system, knownas SEVIS, for all J-1 visa holders. The Participant is required tocomply with all U.S. government visa and immigration require-ments, including the SEVIS requirements as follows: a) Notifica-tion of arrival at U.S. Host Organization to CIEE within 20 daysof the DS-2019 program start date. b) Notification to CIEE ofany change in U.S. home address within 10 days of the change.

21. The Participant is responsible for all of his/her acts along withany resulting loss or damage while on the program. The Par-ticipant agrees to indemnify and hold harmless THI/CIEE fordamages or loss to any party caused by his/her conduct.

22. The Participant is required to maintain communication with his/her Host Organization prior to arrival, notify the Host Organi-zation in advance of his/her arrival and departure dates, andpromptly advise the Host Organization of any changes to his/her travel itinerary due to visa delays or any unforeseen circum-stances.

23. All travel before, during and after the program is at the Partici-pant’s own risk. If the Participant chooses to operate motor-ized vehicles, he/she is responsible for obtaining the appropri-

ate U.S. documents

24. The intention of this program is that the participant returnhome at the conclusion of the training and not pursue em-ployment in the U.S. under another type of visa. Should theparticipant fail to return to Greece at the completion of theFellowship, he/she must repay his/her stipend to THI/CIEE.

25. Once the Participant has commenced his/her travel to the U.S.,THI/CIEE cannot amend the program dates as listed on the

DS-2019 for any reason. It is the Participant’s responsibility tocheck the program start and end dates prior to traveling to tU.S. to ensure that the dates are correct.

26. If during the course of the program the Participant encounteany difficulties with his/her training position, or with safety,health, housing, the Participant should notify THI/CIEE as soas possible by phoning THI/CIEE at 1-888-268-6245. In theevent of an emergency, the Participant can also reach THI/CIat the above number any time night or day.

27. The Participant is required to comply with all U.S. Govern-ment visa and immigration requirements, including the SEVISrequirement as follows:

a. Notification of arrival at U.S. Host Organization to THI/CIwithin 20 days of the DS-2019 program start date.

b. Providing a valid email address and phone number uponarrival at U.S. Host Organization.

c. Notification to THI/CIEE of any change in U.S. home ad-dress, phone number or email address within 10 days of tchange.

28. The Participant agrees that he/she will not engage in anyactivity that would bring the Intern/Trainee Program or theU.S. Department of State into notoriety or disrepute, includiliving in substandard or overcrowded housing. The Participanshould contact THI/CIEE for guidance if any proposed activ-ity might cause this result. If the participant engages in suchactivities, his/her program may be ended prematurely and thparticipant will be required to return home immediately.

29. The Participant agrees to complete an online evaluation atthe mid-point and end of the program, and to assist THI/CIE

in securing mid-point and final evaluations by their internshipsupervisor.

SECTION III.Participant Responsibilities with Respect to His/Her U.S.Host Organization

30. a. Under no circumstances are internships/training positionsguaranteed. A Host Organization’s representation that aposition is being held does not constitute a binding con-tract that the position will be available when the Participaarrives. The Host Organization’s commitment is one ofgood faith only.

b. If the Participant does not have sufficient English profi-ciency, does not arrive on the expected start date, and/o

made any false or inaccurate statement on the applicatiothe offer of a position may be revoked.

c. If the Participant does not meet his/her contractual obligtions with the Host Organization or with THI/CIEE, THI/CIEE may in its sole discretion withdraw or terminate sposorship of the Participant.

31. THI/CIEE is not responsible for the expenses incurred by theParticipant if he/she has not started training by the agreed


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Program Application

date due to financial difficulties of the Host Organization, orfor any other reason not under the direct control of THI/CIEE.

32. Award amounts are based on the length and location of the

internship and are calculated to include visa fees, travel, medi-cal insurance, accommodation, meals, and basic daily livingexpenses. THI/CIEE will provide funding to the Participant’sdependents as part of the Internship/Professional Career Train-ing Program. Award amounts are not negotiable. Exact awardamounts will be communicated in the form of an award reportthat the Participant will be required to sign, date, and returnto CIEE. The Participant should be prepared to bring money topay for discretionary spending (gift shopping, tourist travel inthe U.S., attending cultural events, etc.).

33. The Participant must only train at the Host Organization listedon the DS-2019 form. The Participant is not authorized to seekor carry out any other training or regular employment duringthe period covered by THI/CIEE’s sponsorship. Doing so may

lead to termination of THI/CIEE support. Furthermore, the Par-ticipant must not seek to extend his/her employment or stay inthe U.S. or any other foreign country at the conclusion of theInternship (see Section V below).

34. Participants are solely responsible for their own conduct andwell-being both at and outside their Host Organization. THI/CIEE cannot and does not monitor Participant’s personal con-duct, subject, however, to Paragraphs 27 and 43.

35. The Participant must only train at the Host Organization listedin his/her application and on the DS-2019 form. If for anyreason a change of Host Organization becomes necessary,the Participant must contact THI/CIEE, submit a new DS-7002Form, and obtain approval from THI/CIEE before changing

internship/training positions. Failure to do so will result in theParticipant’s withdrawal or termination from the program.

36. If the actual internship/training position deviates significantlyfrom the terms set forth in Form DS-7002, or if the internship/training environment, for whatever reason, proves unsupport-ive, the Participant should contact THI/CIEE directly. If warrant-ed, THI/CIEE will endeavor to assist the Participant in findinganother position. However, THI/CIEE makes no guarantee thatit will be able to do so and, furthermore, makes no represen-tation that it will be able to find an internship/training positionfor the Participant in the same geographical area or at thesame compensation level.

37. The Participant’s training experience must take place in a pri-marily English-speaking workplace.

38. The Participant must be covered by a Worker’s Compensationpolicy offered by his/ her Host Organization, unless the HostOrganization is exempt by state law.

39. If Participant is terminated by the Host Organization fromthe internship/ training program for non-compliance with theInternship/Training Placement Plan or the work-place rules ofthe Host Organization, he/she may be also withdrawn or termi-nated from the program.

40. If Participant is terminated by the Host Organization or if his/her original internship/training program ends prior to the enddate listed on the DS-2019 form for whatever reason, it is the

Participant’s responsibility to inform THI/CIEE as soon as thisis known and, in any case, before the last day of training. Depending on the situation, the Participant will either be requirto end the program early or allowed to search for a new inteship/training position.

41. Once the Participant has arrived in the U.S. to begin his/herprogram, THI/CIEE will not for any reason refund his/her program fees nor be responsible for the refund of any fees paidthird parties (e.g., the U.S. Department of State, SEVIS, etc.)

42. Per the regulations of this program, Participants may not taka job in addition to their approved training.

SECTION IV.Contractual Terms and Other Program Related Conditions.

43. This English language version of the Intern/Trainee ProgramApplication, including this Participant Declaration, is the binding contract between the Participant and THI/CIEE.

44. THI/CIEE makes no representation or warranty of any kind,expressed or implied, as to the suitability of the program forthe Participant, and THI/CIEE disclaims all such warranties tothe full extent of the law.

45. The conduct of the Intern/Trainee Program is subject to U.S.government approval and may change without notice.

46. While THI/CIEE will always endeavor to fulfill its responsi-bilities, THI/CIEE cannot accept liability or responsibility foralterations, delays, acts of government or public authority, oother circumstances amounting to a “force majeure.”

47. Should any dispute arise regarding the Participant’s obliga-tions arising out of or relating to this Participant Declarationor any other agreement between the Participant and CIEE oTHI, the parties agree that they will attempt to amicably comto a reasonable resolution among themselves. To the fullestextent of the law, the Participant agrees that any controversyor claim (including any counterclaim and the arbitrability of acontroversy, claim, or counterclaim) arising out of or relating this Participant Declaration or any other agreement betweenthe Participant and CIEE or THI that cannot be resolved ami-cably after a reasonable attempt to negotiate such a resolu-tion shall be submitted to arbitration in accordance with theNational Rules for the Resolution of Employment Disputes ofthe American Arbitration Association, as such rules may be

amended from time to time. The award of the arbitrator shalbe final and binding upon the Participant, THI, and CIEE, and

judgment may be entered with respect to such award in anycourt of competent jurisdiction. Should any controversy orclaim (including any counterclaim) arising out of or relating tothis Participant Declaration or any other agreement betweenthe Participant and CIEE or THI be found to not be arbitrablethe Participant agrees to the exclusive jurisdiction of the stat


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Program Application

and federal courts of the state of New York for the resolutionof any dispute.

48. The Participant shall be responsible for and held liable for all

his/her acts along with any loss or damage that results fromthose acts while he/she is in the Program. In the event thatTHI/CIEE, its affiliates and overseas cooperators, and/or anyrespective employees, agents, and representatives of any ofthese entities suffer any loss or damages as a result of the actsof the Participant, then the Participant agrees to indemnify theparty that suffered such loss or damages. Such claims for in-demnification shall cover any and all reasonable claims, causesof action, judgments, losses, costs, or expenses that may bemade against any of the parties listed or that said parties maysuffer or incur as a result of or relating to acts of the Partici-pant.

49. The Hellenic Initiative and the Council on International Educa-tional Exchange, its employees, directors, officers and share-

holders, (collectively, “THI/CIEE”) does not own or operateany entity which provides goods or services for the program,including but not limited to arrangements for or ownershipor control over houses, apartments or other lodging facili-ties; airline, vessel, bus or other transportation companies;food service; or entertainment providers. All such personsand entities are independent contractors and enter into legalrelationships directly with the Participant (and not through THI/CIEE). As a result, THI/CIEE is not liable for any act or failure toact of any such person or entity, or of any third party. Withoutlimitation, THI/CIEE is not responsible for any injury, loss, ordamage to person or property, death, delay or inconveniencein connection with the provision of any goods or services oc-casioned by or resulting from, but not limited to, acts of God,

force majeure, acts of war or civil unrest, insurrection or revolt,strikes or other labor activities, criminal or terrorist activities ofany kind or the threat thereof, over-booking or downgradingof accommodations, structural or other defective conditions inhouses, apartments or other lodging facilities (or in any heat-ing, plumbing, electrical or structural problem therein), me-chanical or other failure of airplanes or other means of trans-portation or for any failure of any transportation mechanism toarrive or depart timely, dangers associated with or bites fromdomestic or wild animals, pests or insects, sanitation problems,food poisoning, disease, epidemics or the threat thereof, lackof, access to or quality of medical care, difficulty in evacuationin case of medical or other emergency, or for any other causebeyond the direct control of THI/CIEE.

50. THI/CIEE reserves the right to provide you with informationTHI/CIEE deems useful to program Participants, including butnot limited to tax, travel and related services.

51. THI/CIEE reserves the right to refuse sponsorship to any Ap-plicant that THI/CIEE deems does not meet program eligibilityrequirements or any Applicant that THI/CIEE does not deemappropriate to accept in the general interests of the program.In the event that THI/CIEE rejects the Applicant’s application

to the program, any applicable refund will be made via theTHI/CIEE Representative through which the original applica-tion was submitted.

52. Program participation begins on the day of departure fromthe Participant’s home country and terminates on the day ofdeparture from the U.S. (so long as this occurs within the legprogram dates). The maximum length of training is 12 monthfor Interns and 18 months for Trainees; however, the overallperiod of time in the U.S. may extend beyond the respectivemaximum durations as follows: The Participant can arrive tothe U.S. a maximum of 30 days prior to the DS-2019 programstart date and remain in the U.S. for up to 30 days beyondthe DS-2019 program end date. The 30 days after the pro-gram end date represent a “Grace Period” extended to theParticipant by the U.S. Government. This period is intendedto be used for travel within the U.S. and the Participant is noallowed to train or to work in any capacity during this time.

Moreover, the Participant also is not allowed to leave andre-enter the U.S. during this period, since the DS-2019 hasexpired.

53. As part of this program, the U.S. Government requires that aParticipants have a certain level of insurance coverage, whichTHI/CIEE includes as a mandatory part of its program. The Pticipant is automatically covered within the internship/traininprogram dates as outlined on the DS-2019 form. Should theParticipant plan to arrive to the U.S. before the program stardate, or to remain in the U.S. after the program end date duing the “Grace Period” as outlined above, this must be madknown to THI/CIEE during the initial processing of the appliction. THI/CIEE cannot be held responsible for any insuranceclaim made outside of the insurance dates confirmed to the

Participant in his/her pre-departure program materials.54. Under the U.S. Government’s Health Insurance Portability

and Accountability Act (HIPAA), THI/CIEE is restricted in itsaccess to certain medical information or records in the eventthat a Participant has an accident in the U.S. In order for THI/CIEE to assist the Participant to the fullest extent possible wiinsurance-related issues, THI/CIEE will need to have a signedPrivacy and Confidentiality Release Form from the Participan(Appendix 2). This form is optional and the Participant canchoose whether or not THI/CIEE is granted access to thisinformation.

55. THI/CIEE reserves the right to dismiss the Participant from thprogram if, in its best judgment, the Participant is deemed

to be a danger to himself/herself or to others, or if his/herconduct is deemed to be detrimental to the program in anyway. In the event of such a dismissal, THI/CIEE shall not beheld responsible for any resulting expenses incurred by theParticipant such as airfare, and shall not be required to returany fees paid by the Participant.

56. Once the Participant has departed for the U.S., he/she willreceive no refund should he/she choose to withdraw or ter-minate his/her program. The Participant will also receive no


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Program Application

By signing below, you indicate that you have read, understood and agree to all terms outlined in the Participant Declaration section.Additionally, by signing below, you also confirm that, to the best of your knowledge, all information contained in the Fellowship for aNew Economy Program Application is true and accurate.

Participant Name:

Participant Signature: Date:

refund should THI/CIEE find it necessary to withdraw sponsor-ship after the Participant has departed for the U.S.

57. THI/CIEE and its Representatives do not provide housing.

Whether the Participant arranges housing independently orthrough the Host Organization where possible, he/she willbe required to sign a lease and pay a deposit, which usuallyamounts to the first and last month’s rent and may include anadditional security deposit.

58. THI/CIEE may provide the Participant’s contact information tothird parties who provide useful services to exchange programParticipants. Third parties receiving this information will berequired to provide the Participant with the opportunity to optout after the first contact.

59. The Participant gives THI/CIEE permission to use any written,photographic, or video images of himself/herself in the courseof reporting on and/or promoting THI/CIEE programs.

60. THI/CIEE retains the right, in its sole discretion, to contactparticipant’s parents, guardian, and/or emergency contact withregard to health issues or any other matter whatsoever whichrelates to participant or participant’s program. These rightstranscend any and all privacy regulations that may apply.

61. The Participant agrees that any dispute concerning, relating, orreferring to the Internship/Training Placement Plan, the Intern/Trainee Program Application, any other literature concerningthe program, or the program itself shall be resolved exclusivelyby binding arbitration in Portland, Maine, according to theexisting commercial rules of the American Arbitration Associa-tion. Such proceedings will be governed by Maine law. Thearbitrator and not any federal, state, or local court or agencyshall have exclusive authority to resolve any dispute relating to

the interpretation, applicability, enforceability, conscionability,or formation of this contract, including but not limited to anyclaim that all or any part of this contract is void or voidable.

SECTION V.Two-Year Home Country Physical Presence Requirement

62. The Participant agrees that upon completion of the THI/CIEE

program, he/she is required to return to, and reside in, thecountry of permanent residency named below for a minimumof two years and is not permitted to stay or attempt to stay ithe U.S. or any other foreign country, including to work, purswork, or study. The Participant agrees that in the event thathe/she does not meet the Two-Year Home Country PhysicalPresence Requirement (the “Residency Requirement”) withothe express consent of THI/CIEE, he/she will refund THI/CIEEthe entire Internship amount, as well as any and all collectionexpenses, including but not limited to legal expenses. THI/CIEE is under no obligation to consider deferment of the Tw

Year Home Country Physical Presence Requirement.

63. The Participant agrees to notify THI/CIEE of his/her return trel dates as specified by the Program Director and to contact

THI/CIEE to arrange an in-person meeting to be held within days of his/her return to his/her country of permanent resi-dency named below. The purpose of this meeting is to reviewthe Participant’s U.S. experience, update contact informationestablish compliance with the Residency Requirement, informthe Participant about THI Alumni Association activities, andlearn about the Participant’s plans for the next two years.

64. During the period covered by the Participant’s ResidencyRequirement, at regular intervals as specified by the ProgramDirector, the Participant is required to provide THI/CIEE withproof of his/her employment or student status in the countryof his/her permanent residency named below. The Participanhas an obligation to inform THI of any change of residencystatus within the next two years.


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Program Application

Appendix 1

Assessment of Applicant’s English Ability (To be completed by professor/docent)Oral English Ability: c Beginner c Intermediate c Advanced

Written English: c Beginner c Intermediate c Advanced

Listening Comprehension: c Beginner c Intermediate c Advanced

Beginner:

Basic competence; conveys andunderstands only very basicmeaning

Intermediate:

Partial command oflanguage; understandsoverall meaning in most situ-ations; able to handle generalcommunication in own field

Advanced:

Fully Competent use oflanguage; able to useEnglish accurately andfluently in any situation

Additional comments about applicant’s English ability:

Name of Professor/Docent:

Telephone:

Name of Educational Institution:

Signature: Date:

Academic Emblem or Seal:


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In partnership with CIEE

Program Application

Appendix 2

Privacy, HIPAA, and Confidentiality Release FormBy completing this form, you give consent to THI/CIEE, your parents or guardian, your physicians and/or other medical providers todiscuss your medical and/or insurance issues with THI/CIEE. You also consent to THI/CIEE utilizing any such material in, and as neces-sary in, treating any medical condition which may arise. You also consent that THI/CIEE may notify your emergency contact listed in thiapplication of any situation that we deem to be an emergency. In addition, you consent that THI/CIEE may notify the official THI/CIEEdesignated agency from whom you purchased this program of any situation that we deem to be an emergency.

This authorization is valid for two years from the date signed.

Under no circumstances can THI/CIEE release medical information from your physician or provider of service to you or anyone. Yourmedical information has been disclosed to us from your physician or provider of service and we are prohibited by federal law fromfurther disclosure. Please contact your physician or provider of service for your medical information.

I give THI/CIEE permission to release any or all of the following information in and as appropriate in the event of a medical condition:

(Please initial and check each box.)

Initial: c All financial and claim information related to medical bills or Claimant’s Statement and Authorization.

Initial: c Provide name, date of service, total charge, total paid, and date of payment.

Initial: c Insurance ID number and/or social security number.

Print Patient Name:

Signature of the Patient, Adult Parent, or Guardian:

Date (dd/mm/yyyy):

THI Application Form

Documents

Transcript of THI Application Form