Application Form

APPLICATION FORM
Deadline: July 1st, 2013

Selection Process. Selection for ICON March 2013 Consulting Project is competitive, and participant spots are limited. The
process includes completing this application and taking part in a short personal interview. The program contribution cost is $1600 for all transport, lodging, most tourist activities and most meals within Panama. Participants will also need to purchase airfare to and from Panama.

Consulting Project Options. Please note, flexibility and exceptions can be made on a personal basis with the dates.
September 13th-21st

• July1st
- Application deadline
• July18th
- Applicants will hear of his/her acceptance
• July20th
- Project commitment/decision expected
- Register a profile, for fundraising/insurance purposes on empowered.org.
• July 25-27th
- Applicants reserve their spot with a purchased plane ticket.
• August 1st
- Acceptable in two payments of $800
- Must be made electronically through ICON’s page on empowered.org.
• First payment scheduled after plane ticket
- Second payment scheduled before departure
- Must be made electronically through ICON’s page on empowered.org.

Benefit of Empowered.org
Empowered.org is a fantastic online fundraising platform. This allows you to reach out and raise awareness to family,
friends, and co-workers for donations to help cover program contribution costs. Additionally, all contributions are tax-
deductible, which include participant payments, or friends/family donations.

  • To start, create a profile and click the orange “Volunteer With Us” button on the ICON March 2013 page.
  • Here you will make all of your program contribution to the ICON page on empowered.org.
  • Additional empowered.org information is included at the end of the application.

Alance Postivo (The boys and girls club of Panama, alcancepositivo.org) is a three-year USAID funded program working in the areas of youth development and violence prevention. Alcance Positivo is a highly collaborative program aiming to strengthen the work of municipal governments, youth centers, community organizations, and community police in youth development and violence prevention. In June 2013, USAID office and financial support ends thus creating the need for a strategic partnership to provide assistance to the youth centers.

Alcance Positivo provides classes in English, computer training, job training and various other activities for individuals aged 12-29.  Approximately 4,000 students are currently enrolled, with over 31,000 reached through all programs.
ICON teams are contuniuing to work on developing a standard operating procedures manual for the 22 different centers.  The manual will be distributed by USAID and United Way in Honduras  Guatemala, El Salvador and other countries throughout Central America.  This standard operating manual will not only help existing youth outreach centers become sustainable, but will also assist new centers in launching.  Strong relationships have been established with executives at USAID to provide ICON consultants with all the necessary data, documents, meetings and resources needed to complete this project.
This project is a tremendous chance to make a massive social impact that will be sustained by multinational foundations such as USAID and United Way.  These youth outreach centers do tremendous work facilitated by directors that have devoted their career to changing the lives of these children.  Please help us in helping the centers reach sustainability, and create a framework for future outreach centers in Central America to follow.

 

Application

Instructions: Please complete Parts 1-4 and click on the 'Submit' button. The deadline to submit applications' is by midnight, January 30th, 2013. Earlier application is encouraged.

Part 1: General Information

Name: Student Number: Degree Program: Date of Birth: Current Address: Email: Telephone: Passport (Country and Number): Expiration Date:

(Note: Your passport must be valid six months beyond your travel date. You may need to renew your passport if it expires in 2013. Info: www.travisa.com . Verify visa requirements with your consulate and check out visahq.com)

Emergency Contact Name: Relationship: Emergency Contact Phone and Email: List any Food/Drug Allergies and/or Dietary Preferences:

Parts 2-4 may be completed and submitted in a separate document, if desired. 250-500 words.

Part 2: Personal Statement

Provide some personal background.
     • Why are you interested in this program? Be specific.
     • How does it suit your personal, professional and academic goals?
     • What skills and strengths will you bring to the ICON consulting project as a whole?
     • What do you hope to learn and gain from this experience?

Part 3: International Experience

Describe any previous experience with cultures other than your own.

     • Have you traveled or worked in Central America or countries where you are not a native?
     • Please be specific.
     • Do you speak any languages other than English?

Form Verification

I am a graduate student or skilled professional and understand that:

1. The program contribution is $1,600

  • $800 of which is paid no later than 2 weeks before departure
  • Tax deductible fundraising for my trip is available through empowered.org

2. I am able to travel outside of the United States

  • My passport does not expire within 6 months of my return

3. I will spend the following 10 weeks upon return working on project deliverables

4. Graduate level university credit is an option though independent study

  • I am responsible for managing the relationship with faculty adviser
  • More work may be required than outline in ICON’s existing syllabus

 I agree to the Terms & Conditions listed above.

For further questions, Sean Buchanan – 425.780.3872.

Further Information

How to utilize empowered.org as a fundraising tool:

Personal Fundraising Page: Customize your personal profile account on empowered.org to share with others about your cause!
• Go to your personal profile page and click “edit profile.”
• Update your personal information and include a photo of yourself.
• Go to “Manage Fundraising Pages” to view current activities.
• Update “My Message,” which will be can be viewed by supporters.
• Click “Tell Friends” to share your personal fundraising page with friends and family via Facebook, email, and Twitter.

Letter Campaign: Or customize and e-mail a donation letter to family and friends asking for support.
• Make it personal.
• Explain why you are interested in this opportunity and what you hope to get out of it.
• Include the URL to your profile on empowered.org.
• Your donors can easily donate to you by simply following the link and clicking the “Donate” button.

**Fly For Good – book with Fly For Good (an agency of American Express Travel) and fundraise to cover the cost of your plane ticket using empowered.org! Contact maggie@iconleaders.org to utilize this service.