Scholarship Acceptance Form
2023-24 PROGRAM YEAR
Family Name First Name Country
INSTRUCTIONS
To accept your 2023-24 YES scholarship, you must sign and return the YES
Scholarship Acceptance Form to your YES program office by April 15, 2023. The Parent/Student
agreement is for your reference and does not need to be returned.
I, , accept the offer to participate in YES,
a program of the U.S. Department of State’s Bureau of Educational and Cultural Affairs
administered by American Councils for International Education.
By accepting the YES scholarship and signing here, my parents or legal guardians and I further
confirm that we understand that my program participation is contingent upon:
1. Acknowledging that I have read and agreed the conditions set out in the Parent/Student Agreement
(below) including all medical, placement, academic, and visa requirements.
LEGAL GUARDIAN initials: STUDENT initials:
2. The COVID-19 pandemic does not severely affect health and safety conditions in my country or in
the United States.
LEGAL GUARDIAN initials: STUDENT initials:
3. I meet U.S. school health requirements, including immunizations.
LEGAL GUARDIAN initials: STUDENT initials:
4. I provide proof of full vaccination against COVID-19 or consent to receive full vaccination upon
arrival in the United States. Refusal to be vaccinated within 60 days after arrival will result in my
dismissal from the program.
LEGAL GUARDIAN initials: STUDENT initials:
5. My placement organization is able to secure a family and school placement.
LEGAL GUARDIAN initials: STUDENT initials:
6. I am able to obtain a U.S. visa.
LEGAL GUARDIAN initials: STUDENT initials:
7. I meet U.S. entry requirements.
LEGAL GUARDIAN initials: STUDENT initials:
8. There is regular and reliable commercial airline travel between the United States and my country.
LEGAL GUARDIAN initials: STUDENT initials:
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Scholarship Acceptance Form
2023-24 PROGRAM YEAR
My parents or legal guardians and I further confirm that we understand and agree to the following
terms of participation:
1. I understand it is important to give accurate information about medical issues, including mental
health. If a student has a medical crisis requiring urgent treatment, like hospitalization, the U.S.
medical provider will need immediate access to the student’s medical history to help the student
quickly and effectively.
LEGAL GUARDIAN initials: STUDENT initials:
2. I cannot choose my host family or where I will be placed. I understand that many students are
placed in small towns (5,000 or fewer inhabitants).
LEGAL GUARDIAN initials: STUDENT initials:
3. I will likely be placed in a host home that has an indoor pet (most commonly dogs, but potentially a
cat or other pet).
LEGAL GUARDIAN initials: STUDENT initials:
4. I will not be able to keep up with my home country studies. Attempting to do so will limit and
negatively impact my ability to fully contribute to and get the most out of my exchange year. I also
understand that my placement organization or the program may require that I limit or stop any such
studies.
LEGAL GUARDIAN initials: STUDENT initials:
5. I confirm that I meet my country’s age and grade requirements for participation in the program, and
confirm that I have not changed my grade since applying to the program.
LEGAL GUARDIAN initials: STUDENT initials:
ACCEPTED AND AGREED TO BY:
Signature of Participant Participant’s Name (Printed) Date
Signature of Parent or Legal Guardian Parent’s or Legal Guardian’s Name (Printed) Date
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Parent/Student Agreement
2023-24 PROGRAM YEAR
INSTRUCTIONS
Before you sign and return the YES Acceptance Form, carefully review the Parent/Student Agreement
you signed when you submitted your application. You do not need to return this agreement with the
YES Scholarship Acceptance Form.
A. PURPOSE for a minimum of two (2) years after completing their exchange
The Youth Exchange and Study (YES) program (referred to below as “the program in the United States before they are eligible for an
Program”), sponsored by the United States Government, promotes immigrant visa, U.S. permanent residence, or a non-immigrant H or L
friendship between the United States and your country, and provides visa.
opportunities for personal development through international host 7. I understand that if my child is selected to receive a scholarship,
family living. final acceptance will depend on fulfillment of the medical,
placement, and academic requirements of the Program.
The U.S. Department of State implements the Program with the
8. I understand that I may not visit my child during their time on
assistance of private, not-for-profit organizations (referred to as
program in the United States unless I obtain prior written approval
“Program Organizations”). While in the United States, students will be in
from the Placement Organization.
the care of “Placement Organizations” that identify and arrange host
9. I agree to release and discharge the Program Organizations and their
families and schools and provide support and guidance for participants
employees and agents; host families; Program representatives;
during the exchange Program. Participants attend a U.S. school, share in
school representatives; and the U. S. Department of State and its
American family life, learn about the United States, increase their
employees, agents, and instrumentalities from any legal liability,
sensitivity to cultural differences and similarities, and develop a
claim, or demand in connection with:
deepened awareness of shared human values and interests. The
a. any emergency, accident, illness, injury, or other consequences
Program, consistent with its commitment to mutual understanding
or events arising from the actions or participation of our child in
between the people of the United States and people of other countries,
the Program.
encourages cultural diversity in the selection of Program participants
b. any cause, event, or occurrence beyond the control of the
and host families. Participants are required to return to their home
Program Organizations or the Department of State, including, but
country after their Program, where they are expected to share their
not limited to, natural disasters, war, terrorism, civil disturbances,
experiences in the United States.
and the negligence of parties not subject to the control of the
This document must be signed by a natural parent or legal guardian of Program Organizations.
the participating student (referred to as the “Parent”). c. any actions or negligence of commercial airlines, trains, buses,
restaurants, hotels, and other entities engaged for travel-related
B. PARENT AGREEMENT services, including, but not limited to, lost baggage,
GENERAL PROGRAM POLICIES uncomfortable accommodations, and travel delays.
1. I give my child permission to participate in this Program. I and my
child will obey the policies described in the Program Handbook and TRAVEL POLICIES
Program Organization guidelines. I understand that the original 10. I agree that my child will travel to and from the United States in strict
English-language version of this document represents the final accordance with the travel plans made by the Program.
authoritative wording of policies and guidelines. 11. I will not encourage or permit my child to travel outside the host
2. I understand that if I or any other immediate family member has community during participation in the Program except in strict
applied at any time to emigrate to the United States or if I or any accordance with the following requirements:
other immediate adult family member (whether estranged or not) is a. If my child desires to travel outside the host community with and
a U.S. citizen or green card holder, it may negatively affect my child’s under the supervision of their host parent(s), school official, or
eligibility for the Program. other responsible adult, my child must first obtain written
3. I understand that if another member of my immediate family will be approval for such travel from the Placement Organization.
living in the United States at the same time my child would be International travel requires prior authorization and an additional
participating in the Program, it may affect my child’s eligibility for the U.S. Department of State signature on the Form DS-2019.
Program. b. If my child desires to travel outside the host community
4. I affirm that my child has not stayed in the United States for more unaccompanied by their host parent(s), school official, or other
than ninety (90) days in total during the past five (5) years. responsible adult, my child must obtain prior written approval for
5. I understand that my child must meet the Program eligibility such travel from the Placement Organization and me, the child’s
requirements, be a citizen or permanent resident of the country in Parent. Please note, some Placement Organizations may not
which s/he is applying, and be able to obtain a passport from their allow such travel. International travel requires prior
country of citizenship and a J-1 visa for entry into the United States. authorization and an additional U.S. Department of State
6. I understand that participants in an exchange visitor program signature on the Form DS-2019.
funded by the U.S. Government are required, under Section 212(e) of c. I understand that many Placement Organizations limit or do not
the Immigration and Nationality Act, to reside in their home country allow visits with natural family members or friends from the
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home country. I agree to follow all Placement Organization rules I understand that omitting information on the Student Health
concerning visits with natural family members or family friends. Certificate could endanger the health of my child and may be
12. I understand that my child will be responsible for paying any fees grounds for dismissal from the Program. I will immediately inform
incurred for carrying baggage in excess of the baggage limits set by the Program Organization of any change in information. I
the airlines used for Program travel. I understand that this provision understand that any physical or mental health condition requiring a
applies to both international and domestic travel within both the significant and sustained level of care or monitoring of my child may
United States and our country. require reconsideration of my child’s participation in the Program. In
13. I understand that in making travel arrangements for my child, the the event my child has a recurrence of any previous illness or any
Program Organizations contract with or use commercial airlines, condition contracted before leaving home or in the United States
trains, buses, restaurants, hotels, and other entities whose that is not covered by insurance provided by the Program, I
performance and services cannot be controlled by the Program. I authorize the Program Organization to release my child to my care in
agree that the Program Organizations reserve the right to change or our home country. I will not hold the Program Organizations and
alter travel, lodging, or other arrangements if they believe such their employees and agents; host families; Program representatives;
change or alteration to be in the best interest of the participants or school representatives; or the U.S. Department of State and its
the Program. employees, agents, and instrumentalities responsible for any debts
14. I understand that our child must return home at the end of the incurred in connection with this permission. I understand that
Program on the date assigned by the responsible Program treatment will be provided for injuries sustained by my child while
Organization. Changes to the assigned departure date will not be on Program, but the extent of coverage is subject to the Program’s
made to accommodate graduation, prom, or other special school or insurance provider’s rules and policies.
family events that occur after the assigned date. I understand and 20. I confirm that I have provided a full and complete medical and
agree that the Program end date indicated on the form DS-2019 immunization history for my child. I understand that U.S. schools
issued to my child will not be amended or extended. No exceptions require immunizations and I agree to allow the Program
will be made to this policy. Organizations to arrange for all immunizations required for my child.
I understand that such immunizations will be administered
SCHOOL AND HOST FAMILY PLACEMENT according to U.S. medical standards and at no expense to me or my
15. I authorize the Placement Organizations and their employees and child.
representatives to change the place of residence or school 21. As the applicant’s Parent, I agree to and authorize the Placement
designated for my child when they believe such change to be in our Organization, its personnel and representatives, and the adult
child’s best interest. I understand that I will be notified of any such members of the host family, to act for me in any emergency,
changes. accident, or illness.
16. I recognize that schools in the United States may impose academic
standards or other requirements in determining grade level TERMINATION FROM THE PROGRAM
placement that differ from those imposed by the school my child 22. I understand that my child may be dismissed from the program for
now attends. I acknowledge and accept that participation in the behavior that the Program Organizations, with the concurrence of
Program does not guarantee credit or graduation from the school my the U.S. Department of State, consider inappropriate or detrimental
child now attends or from the U.S. school my child will attend while to my child or to the program. Inappropriate or detrimental behavior
participating in the Program. I and my child will accept the grade may include, but is not limited to, violating host family or school
placement assigned by the U.S. school. I understand that it is my rules, academic under-performance, or failure to participate in
responsibility to arrange with the school our child now attends to program activities. It may also include inappropriate sexual behavior,
receive credit or to take exams upon completion of the Program; or including but not limited to the viewing and sharing of sexually
to arrange for permission for academic absence from any institute or explicit material, verbal or physical harassment, and any violation of
university to be attended upon return. U.S. law.
17. I am aware that the United States is a multi-racial, multi-ethnic 23. I agree that if I violate any provision of this Agreement, or if my child,
country providing a diversity of possible living experiences and that while in the United States, does any of the following, then it may be
there is no single living experience that is typical. I understand that determined that my child has voluntarily withdrawn from the
placements are made based on criteria designed to determine Program:
suitability of host families, and the Program does not illegally a. is absent without authorization from the host school or the place
discriminate on the basis of race, disability, religion, gender, or of residence designated by the Placement Organization; or
ethnic origin, with respect to either students or host families. b. has misrepresented themselves in the Program application.
18. I understand that there are strict laws restricting smoking by people 24. If my child voluntarily withdraws or is dismissed from the Program at
under the age of 21 in the United States. I understand that the host any time after departure from our country, I understand that their
family may have objections to smoking in their home and that scholarship, Program status as a J-visa holder, and health insurance
schools forbid smoking or the possession of tobacco products. The coverage will be canceled.
import and sale of tobacco products (including cigarettes,
e-cigarettes, cigars, etc.) are restricted for people under the age of DECLARATION
21. I and my child agree to honor all U.S. laws and host family, school, 25. I have discussed the Program and this Agreement with my child, and
and Placement Organization restrictions. each of us fully understands the obligations imposed on us.
26. I confirm that all information provided in my child’s application
HEALTH/MEDICAL ISSUES materials and this Agreement is truthful. I understand that any
19. I confirm that the information stated in the Student Health Certificate misrepresentation or false answer in this application can be
is accurate and contains no material omissions of which I am aware. grounds for our child’s termination from the Program.
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Policies
2023-24 PROGRAM YEAR
The policies presented here are the general policies for students. Since variations
regarding specific policies and procedures exist among Placement Organizations,
it is important that you check with the representatives or office of your Placement
Organization in the United States.
PROGRAM ELIGIBILITY REQUIREMENTS
Applicants will be considered for participation in this Program if:
1. The applicant meets the Program age and grade (class) requirements for his or her country; and
2. The applicant is a citizen or permanent resident of the country in which they apply.
GENERAL POLICIES
• INTERNET: Students are required to follow ALL RULES regarding use of computers, tablets, cell phones, and the Internet as
determined by their Placement Organization, host family and/or host school. Students who place private (contact information,
pictures, etc.) or other information on the Internet in violation of the rules established by their Placement Organization, host family
and/or host school may be dismissed from the Program. These Placement Organization rules are intended to protect students’
safety. Violation of any of these rules may result in dismissal from the Program. Students also may be subject to prosecution for
any violation of law.
• RISKY OR DANGEROUS ACTIVITIES: The following activities have been determined by most insurance companies to be too risky,
and treatment for injuries sustained while participating in them is not likely to be covered by insurance: Driving any motorized
vehicle (See Driving Motorized Vehicles section below), riding as a passenger in off-road vehicles or in non-commercial aircraft,
hang gliding, bungee jumping, jumping on a trampoline, parachute jumping, parasailing, scuba diving, piloting a private plane,
mountain biking, mountaineering, rock climbing, skate boarding, extreme sports, and handling or using a firearm or other weapon.
Participants are not permitted to engage in any activities not covered by program insurance. In addition, participants are not
permitted to engage in any activities prohibited by their Placement Organization, even if the activity is covered by insurance.
• DRIVING MOTORIZED VEHICLES: Exchange students are not permitted to drive any motorized vehicle under any circumstances
while participating in the Program in the United States. Violators of this policy will be considered for Program dismissal. This
applies even if students are in possession of an International driver’s license or if the host family feels that the student is a
responsible and careful driver. Exceptions may be granted for farm equipment if allowed by the student’s natural parents and
Placement Organization. If authorized, the student must observe precautions regarding safety and legal limitations. Exchange
students are not permitted to pilot any aircraft under any circumstances while participating in the Program.
• EMPLOYMENT: The J-1 visa status permitting students to stay in the United States restricts employment. Program participants may
not be employed on either a full or part-time basis but may accept sporadic or intermittent employment such as babysitting or
yard work.
• MARRIAGE AND PREGNANCY: If marriage occurs while the student is a participant or is discovered to have occurred prior to the
student becoming a participant, the student will be considered for dismissal from the Program. Students who are discovered to be
pregnant or to have caused a pregnancy must return home.
• STUDENT EXPENSES: The Program provides travel arrangements, host family and school placements, allowances, and insurance.
In addition, the Program provides the Form DS-2019 that is required to apply for a J-1 visa at a U.S. embassy or consulate. The
Program is not responsible for additional student expenses beyond the incidentals allowance, monthly pocket allowance, and
official Program activities and travel. The host family is responsible for three meals a day for the student and must provide EITHER
lunch money OR a bag lunch. All other expenses, such as extra school fees or activities, social activities, personal and hygienic
supplies, postage and telephone calls, are paid by the student using Program allowances.
TRAVEL POLICIES
• RETURN TO HOME COUNTRY AT THE END OF THE PROGRAM: All students must return to their home country at the end of the
program on the date assigned by the responsible Program Organization. Students will not be allowed to remain in the United
States after their assigned return-travel date. Those who do not adhere to this may be reported to the Department of Homeland
Security and will have their program insurance canceled.
• STUDENT TRAVEL: Only authorized student travel is permitted. Authorized student travel must meet these three criteria:
a. The Placement Organization has knowledge of the student’s location and approves the travel in advance, and/or the
Program Organizations have obtained the Parents’ written permission for the travel;
b. The student’s safety is assured to the greatest extent possible; and
c. The travel does not interfere with school attendance.
• NATURAL FAMILY VISITS: Visits with natural family or home country friends or relatives who live in the United States are
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strongly discouraged during the Program year, especially during the initial adjustment period. Such visits interrupt the continuity
of the relationship with the host family and may diminish the exchange experience for the student and host family. Policies vary by
Placement Organization.
• VISITS TO THE HOME COUNTRY WHILE ON PROGRAM: Such visits are not allowed. Exceptions may be made, contingent upon
identification of a source of funding and Program approval, in the case of the death or imminent death of an immediate family
member. An unauthorized visit will result in dismissal from the Program. Such non-emergency trips break the continuity of the
relationship with the host family and may diminish the exchange experience for the student and host family. Any requests for
exceptions must be presented to the Placement Organization and approved by the U.S. Department of State.
SCHOOL AND HOST FAMILY PLACEMENT
• SCHOOL ATTENDANCE: All Program participants must attend a high school and maintain a normal course of school work. Non-
attendance may result in consideration for Program dismissal or determining that the student has left the Program.
• SCHOOL PERFORMANCE: Allowing for an initial period of adjustment, participants must achieve and maintain adequate academic
results. After a reasonable period of time, poor motivation, under-achievement, or inappropriate behavior in combination with poor
family adjustment, may be cause for dismissal from the Program.
• SCHOOL EXPULSION: If a student is expelled from school, it may result in Program dismissal.
˚ Students and Parents cannot choose their host family, school, grade placement, or location of placement. Placement
organizations will request agreement of the student and Parents if a student will be 1) placed in a home with another exchange
student [a double placement]; 2) placed with a single host parent without children in the home; or 3) enrolled in a school run
by a religious organization.
˚ Participants cannot be hosted by natural family members.
HEALTH/MEDICAL
• MEDICAL TREATMENT OF A STUDENT (INCLUDING EMERGENCIES): Before a student arrives in the United States, the Program
must receive written permission from Parents to obtain emergency medical attention if needed (see Permission for Care of My
Child). Students will receive medical attention in case of an accident or emergency. The insurance provider is determined by each
Placement Organization. Each insurance provider has specific policies and restrictions governing the types of expenses it will
reimburse. Placement Organizations, their representatives and host families are not responsible for any medical bills not covered
by insurance regardless of who signs the hospital admission form. The Program also is not responsible for any negative results
because of medical treatment.
ILLEGAL ACTIVITY
• Students may be subject to prosecution by the U.S. legal system and may be dismissed from the program if they engage in illegal
activity, such as:
• ALCOHOL: Participants are required to observe all U.S. laws with regard to the minimum drinking age. The minimum drinking
age in the United States is 21.
• DRUGS: Participants are prohibited from selling, using, distributing, sharing, or possessing any drugs that are illegal under
federal, state, or local law, including, but not limited to, marijuana and unauthorized use of prescription drugs. Any drug
infraction is considered a grave violation of policy and may result in dismissal from the program.
• SMOKING: There are strict laws restricting smoking in the United States. The legal age to buy tobacco in the United States is 21
years old. According to the Food and Drug Administration (FDA), tobacco includes cigarettes, smokeless tobacco, hookah
tobacco, cigars, pipe tobacco, electronic nicotine delivery systems including e-cigarettes and e-liquids.
• THEFT OR SHOPLIFTING
• ANY OTHER ACTIVITY THAT IS AGAINST U.S. LAW or that results in the participant being arrested or charged with a crime.
• LEGAL COUNSEL: Neither the Program Organizations nor the Department of State is obligated to provide legal counsel or defray
representation expenses or fines of any sort should a Participant be charged with any crime or do something that attracts the
attention of law enforcement officials. In such cases, the participant is subject to all local, state, and federal laws.
OTHER GROUNDS FOR TERMINATION
• LEAVING THE PROGRAM EARLY: If the student is absent from the host family, school or other place to which the Program has
assigned them without obtaining the advance written approval of the Program, the Program may determine that the student
has left the Program through their own voluntary action. In this case, the Program is absolved from all obligations, legal or
otherwise, to the student or their Parents for the student’s current or future well-being. The Program will, if the circumstances
warrant, work with the student to return to the Program. However, if this cannot be accomplished, a decision will be made that
the separation from the Program is final, and the student will receive a letter from the Program sponsor indicating that the
student has been reported to the Department of Homeland Security in the Student and Exchange Visitor Information System
(SEVIS) database. The participant’s medical insurance and health benefits will be canceled.
• UNAUTHORIZED TRAVEL may constitute termination from the Program: The Placement Organizations in the United States
determine authorization for travel. Procedures for obtaining permission to travel vary by Placement Organization.
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