WILDCATS WORLDWIDE
CW U C O NTINU I N G ED U C A TI O N YO U TH CU L TU R AL
I M MER SI O N 2016
Wildcats Worldwide will be held at Central Washington University’s Ellensburg
Campus August 1-19, 2016.
Program
Information
This summer, the office of Continuing Education at Central Washington University
has teamed up with the JLS Academy to offer Wildcats Worldwide. Over three
weeks, beginning August 1st, 2016, twelve local students, ages 12-15, will discover
the fun of being on a college campus as they participate in engaging activities with
twelve international students from Korea. The program, Wildcats Worldwide,
empowers youth to learn about their world, cultivate leadership and civic
engagement, build lifelong friendships across cultures, and promote the skills and
motivation to make a difference in society.
How to Apply
Applications are due by June 15th, 2016. Screening will be completed by July 1st,
2016. To apply visit www.cwu.edu/ce/wildcats-worldwide. The application consists
of the form, short essay, letter of recommendation from a teacher, principle, school
counselor, etc., and copy of your most recent report card. Applications may be
submitted by mail, fax, or email.
Cost
The total cost for all three weeks of the program is $475.00. There is a
nonrefundable registration fee of $25.00 that will include a Wildcats Worldwide
Camp tee shirt for students who are accepted into the program. The cost will cover
all tuition and fees, materials, and student lunches. Please see below for the
refund policy.
Selection Criteria
Participants will be selected on a competitive basis. Preference will be given to
students with a 3.0 or better GPA. However, outstanding students and those
without these prerequisites will be considered. Neatness, accuracy, and following
directions will also be considered. The selection committee will meet to review
applications at the end of June and students will be notified of acceptance by no
later than July 1st, 2016.
Application
Checklist
□ Completed Application with fee
□ Short essay
□ Letter of recommendation
□ Copy of report card
□ Signature of applicant
□ Signature of parent/guardian
Essay Requirements
In one page or less, explain why you feel you would be an ideal candidate for Wildcats
Worldwide and what you hope to gain from connecting with students from another culture.
Please type or print your essay on a separate sheet of paper.
For questions, please contact:
Office of Continuing Education
400 E University Way - Barge Hall
Ellensburg, WA 98926-7433
Phone: 509-963-1712
Fax: 509-963-1690
Email: conted@cwu.edu
www.cwu.edu/ce
WILDCATS WORLDWIDE
APPLICATION
Application deadline is Wednesday, June 15, 2016.
Please complete the application form in ink and return with a copy of your report card, essay,
and recommendation letter. Completed applications may be submitted by mail, fax, or email.
Mailing Address: Office of Continuing Education,
400 E University Way,
Ellensburg, WA 98926-7433
Fax: 509-963-1690
Email: conted@cwu.edu
Legal name __________________________________________________________________________
First
Middle
Last
Suffix (Jr., II, etc.)
Preferred name/nickname ______________________________________________________________
PARTICIPANT’S CONTACT INFORMATION
Email Address
_________________________________________________________________
Telephone Number
(______)__________________________________________________________
Address/P.O. Box
_________________________________________________________________
City
_________________________________________________________________
State
_________________________________________________________________
Zip/Postal Code
_________________________________________________________________
PERSONAL INFORMATION
SCHOOL INFORMATION
Gender
_______________
What is the name of the school you attended this year?
Birth date
_______________
______________________________________________________
Age
_______________
What grade will you have completed by June 2016? ____________
PARENT/GUARDIAN INFORMATION
PARENT/GUARDIAN INFORMATION
______________________________________
_________________________________________
First name
First name
Last name
Suffix
Last name
Suffix
Relationship to applicant __________________
Relationship to applicant
________________________
Cell phone number
Cell phone number
(_____)_______________
(_____)__________________
Work phone number (_____)_______________
Work phone number (_____)__________________
Email address
Email address
_____________________
Is your address the same as the participant’s? □ Yes □ No
________________________
Is your address the same as the participant’s? □ Yes □ No
FOR PARENTS/GUARDIANS
Campus Policies
Programs are intended to be educational and fun. To ensure campers have a positive
experience we have instituted the following policies.
Sign-in/Sign-out Procedure
You must escort and sign your child in at his/her destination. At the end of the program, your
child must be picked up and signed out. Campers are only permitted to leave camp with a
parent/guardian or individual identified by parent/guardian in a written request.
Camper Code of Conduct Agreement
Camper safety is our priority. Cursing, bullying, name-calling or behavior deemed unsafe by
camp staff compromises the experience for everyone and will not be tolerated. Parents or
guardians will be notified if campers exhibit these negative behaviors. If immediate improvement
in behavior is not evident, the camper will be dismissed from camp without refund. Dangerous
behavior, such as fighting, is grounds for immediate dismissal. Cell phones/other electronic
devices must be turned off prior to camp start time.
Meals
Meals will be provided by the Wildcats Worldwide program and include buffet style cafeteria
food. If your child has a food allergy, please be sure to include it in the Medical Information
section below.
Refund Policy
If a parent/guardian must cancel his/her child’s camp registration(s), our refund policy is as
follows: for cancellations on or before July 15th, 2016 payment will be fully refunded except for a
$25 non-transferable registration fee; cancellations after July 15th, 2016 will be refunded 50%
and the registration fee will be retained; no refunds will be issued once the camp program
begins. Appeals require documentation of an emergency. Central Washington University (CWU)
reserves the right to cancel a camp in which the registration is less than the minimum required.
If CWU cancels a camp, full refunds will be automatically granted. Refunds will be issued in the
form of a check; please allow 4-6 weeks for processing.
Publicity
My child is permitted to participate/appear in group camp photos or videos that may be used in
future camp brochures, CWU’s website, or any of CWU’s social media pages.
Please check one:
□ Yes □ No
Medical Information
Does your child have allergies (food, drug, or environmental)?
□ Yes
□ No
If yes, please list.
____________________________________________________________________________
Is your child taking any medications?
□ Yes
□ No
If yes, please explain.
____________________________________________________________________________
Name of medication(s) and dosage(s).
____________________________________________________________________________
Name of Physician
___________________________________________________________________________
Phone Number (______) ____________________
Medical Insurance
____________________________________________________________________________
Name of Insured
____________________________________________________________________________
Policy/Group#
____________________________________________________________________________
Emergency Contact Information
In case of an emergency, please contact:
1) ____________________________________
______________________________________
Primary Emergency Contact
Relationship to child
(_______) ______________________________
(_______) ______________________________
Cell Phone number
Work Phone Number
2) ____________________________________
______________________________________
Secondary Emergency Contact
Relationship to child
(_______) ______________________________
(_______)______________________________
Cell Phone number
Work Phone Number
I, the undersigned, individually and as a parent/guardian of _______________________ (camper),
a minor, ask that he/she be admitted to participate in Continuing Education’s Youth Summer
Program sponsored by Central Washington University’s Continuing Education Department. I do
herby agree to release, discharge, and hold harmless the State of Washington and Central
Washington University, its officers, agents, trustee, employees, and volunteers form any and all
liabilities, claims, costs, expenses, injuries, and/or losses that I or my minor child may sustain as
a result of my minor’s attendance at the Continuing Education’s Youth Summer Program or in
the course of activities held in connection with the camp. I hereby give consent for medical
treatment and agree to assume all responsibility for payment of medical bills and expenses.
Furthermore, I will be responsible for filing all claims with all insurance companies. You have my
permission to release a copy of this form and the personal insurance information above to any
medial provider treating my child.
________________________________________
_______________________________________
______________
Parent/Guardian Signature
Parent/Guardian Printed
Date Signed
________________________________________
_______________________________________
______________
Camper’s Signature
Camper’s Printed
Date Signed
HOW DID YOU HEAR ABOUT OUR PROGRAM? (Please check all that apply)
□ Counselor/teacher
□ Summer Youth Programs Website
□ Friend
□ Social Media
□ Advertisement
□ Internet Search
□ Event
□ Other _________________________________