Zhengzhou International Young Leaders Summit (ZIYLS) Application
Innovation and Maker is the theme of the upcoming China Summit. Selected delegates will be actively engaged in
discussing technology and innovation, maker, peace, economy, globalization, and how to preserve quintessence of
the different cultures. This summit will also offer an invaluable opportunity to the participants to visit The Great
Wall of China, The Forbidden City (the old palace), Shaolin Temple (the birth place of Kungfu), Kaifeng Folk Village,
and the ancient civilization site around Yellow River. The dates of this trip will be from October 16 to October 25,
2016.
Important dates:







INTEREST MEETING (STUDENTS): MAY 4TH
AT 8:15 AM in the auditorium.
INTEREST MEETING (PARENTS): MAY 12TH
AT 7:00 PM IN ROOM 401.
APPLICATIONS DUE MAY 20TH
APPLICANTS NOTIFIED MAY 25TH
DEPOSIT ($500) DUE AND PARTICIPANT
MEETING: JUNE 1ST
REMAINDER OF PAYMENT DUE
SEPTEMBER 14TH
FALL 2016 – A schedule of meetings will be
announced upon the start of the 20162017 school year.
Eligibility:
Students must be enrolled in Academic or A.P.
World History, Academic or A.P. Government or
Academic or AP Economics or International
Relations in the 2016-2017 school year to apply.
Additionally, students who are members of the
Model United Nations Team may apply.
Each student will connect their social science
research paper to some aspect of Chinese history,
politics, or culture.
Interested students must: 1. complete the written application; 2. have two teachers complete
recommendations
Name______________________________ Grade_________
Address:____________________________ Home Phone #:_____________________
___________________________________ Parent Cell Phone #:_________________
Student Cell Phone #:________________
Parent E-mail address____________________________
Student E-mail address___________________________
Parent signature _________________________________
I have read the information about the Cuba Study Visit in which my child would like to participate and support their desire to take part in this
opportunity.
Coach signature __________________________________
Please have your coach sign if you are participating in a fall sport to indicate that you have discussed this opportunity and the impact that your
participation will have on the team with him/her.
Written application instructions
Answer the following questions on a separate sheet of paper. Utilize no more than two sheets of paper in
total to answer the following:
1. List the extra-curricular activities in which you participate, leadership positions you hold, and
community service projects in which you have taken part.
Activities and leadership experiences that demonstrate an ability to learn outside of the classroom,
adaptability, and an appreciation for other cultures are highly desirable.
2. Why do you feel you would make a good “ambassador” from Dominion High School and the United
States during this visit to China?
Ideal candidates will be able to articulate the character traits that they possess, as well as prior life
experiences that have prepared them to represent Dominion and the U.S. on this trip. Prior international
travel experiences are not necessary, but candidates should demonstrate that they understand the
perceptions that Chinese may have of them, as well how they plan to leave a positive impression of
Dominion High School and America with Chinese people they will encounter on this trip.
3. What do you hope to gain from taking part in this trip?
Ideal candidates will be able to articulate how this trip will contribute to his/her “leading a life of
significance.”
Application Rubric:
Applications will be judged by the following criteria:




Teacher recommendations (25%)
Response to question #1 (25%)
Response to question #2 (25%)
Response to question #3 (25%)
Return completed applications to Mrs. Carter and Mrs. Kim.
2016 China Summit Teacher Recommendation Form
Students are required to submit 2 teacher recommendation forms to be considered for participation in this
program. Please respond to the following questions, based on your relationship with the applicant, as
accurately and honestly as possible. Please keep in mind the physical and emotional rigors that these
international travel opportunities present, as well as the desire to have the students participating serve as
excellent representatives of Dominion High School and the United States.
Thank you!
Mrs. Kim and Mrs. Carter
Return the evaluation forms to Mrs. Kim (turn in to Mrs. Brothers in the Media Center) or the Mrs. Carter’s
mailbox in the main office.
Student Name: __________________________________
Teacher Completing Recommendation: _______________________________
Relationship to Student: ____________________________________
Characteristic
Exceptional (Top Above
3% of class)
Average
Average
Below Average/
Does not exhibit
Leadership
Independence
Responsibility/Maturity
Character
Academic Achievement
Openness to new
experiences
Additional Comments:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
China Summit Trip: October 2016
Dates:
October 16 to October 25, 2016.
Estimated Costs:
Air fare to China (TBA at the parents’ Meeting).
**Zhengzhou Number 2 High School will provide lodging, meals, and transportation fares during the summit, and
admission fees to the Great Wall of China, the Forbidden City, Kaifeng Folk Village, and Shaolin Temple.
Accomodations and Itinerary:
A more detailed itinerary will be made available at the interest meetings.