Kennedy-Lugar Youth Exchange & Study (YES) Program 2025-26

YES Application

Picture
Application ID: YPK-2DM0VX Not more than 6
months old

Registered e-mail address: ____________________________________________________

mdmkhan71@gmail.com

Student Information:

Student’s Name: __________________________________

Zalan Alam sikandar Father’s Name: ________________________________
Sultan Sikandar

Gender: ___________________________
male Date of Birth: _______________________________________________
Jan/01/2011

Home Address: _______________________________________________________________________________

Village lilownai tehsil alpurae district shangla

City: ________________________
Alpurae District: _________________________
Shangla Province: KPK
________________________

Cell No. 1: _____________________________________

03070987822 Cell No. 2: ______________________________________
03038507224

Have you applied for immigration in the US or any other country? Yes
✓
No

If yes, what country? _________________________ Have you ever traveled to the US? Yes
✓
No

Has your sibling been on the YES program? Yes

✓
No if yes, write name: _________________________

Participated year: ______________________________

School Information:

Name of School: _________________________________________________________________________________

Pak turk maarif international school Peshawar

Branch (if any): ___________________________________

Hayatabad branch Current Class (2024-25): __________________________
9

School Address: _________________________________________________________________________________

Phase 5 hayatabad near northwest hospital Peshwar

City: ______________
Peshwar District: _______________
Peshawar Province: KPK
_______________ Phone No.: 091-5891493
____________________

Please note: This application is code generated and cannot be used for multiple students. Each
student must register himself / herself separately to download the YES-2025-26 application. Soft
copy of YES Application will not be accepted.
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 FORM 1 Application
YPK-2DM0VX

Cover Sheet

Student Information:
LAST (FAMILY) NAME:

FIRST NAME:

MIDDLE NAME, IF ANY: _

GENDER (select one): MALE FEMALE AGE:

YES PROGRAM DATE OF BIRTH: Please write DOB as DD/MM/YY

APPLICATION CITY OF RESIDENCE:

2025-2026 COUNTRY OF RESIDENCE:

CITIZENSHIP(S): _
IF MORE THAN ONE, LIST ALL.
DUE DATE:
School Information:
Return the completed
application and one copy SCHOOL CITY:
to your YES program office.
SCHOOL NAME:

INSTRUCTIONS: CLASS (choose one):

8 9 10 11 12 I II III IV 1 2 3 4
Note to student: Please read all of the
instructions carefully before you start Other:
to fill out this application. Specific
instructions for each form are located SCHOOL TYPE: Public Private Other:
at the top of the form, and additional
instructions are located on the last Is school transcript included? Yes No
page of this application.

You must complete every section on

each form in this application, and
Questions for Student:
return the completed application by
Is Form M (Student Health Certificate) included? Yes No
the due date. If you do not return the
completed application by the due
Is Form 4 (Recommendation from Teacher) included? Yes No
date, your application will not be
considered. Are passport size photos included? Yes No

• Write your name at the top of each Have you participated in the English Access Microscholarship Program (Access)?
form where indicated.
• Complete all forms in English only.
Yes No
• Complete all forms using BLACK ink.

Read and Initial:

By submitting this application, I confirm that all of the information

in it, my health form, and my previous essays are accurate and true.
All written work is my work. I understand that providing false
information or using Artificial Intelligence (ChatGPT, OpenAI, etc.)
will lead to disqualification or my expulsion from the program.

Student initials: Date:

This Application is FREE OF CHARGE

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 FORM 2 Host Family
YPK-2DM0VX

Letter

STUDENT NAME:
2025-2026
Last name First name Middle name

INSTRUCTIONS
Write your U.S. host family a letter:
• Introduce yourself and your family. What activities do you enjoy doing together? • Write two or three sentences to describe your city.
What are your responsibilities at home? • What plans, if any, do you have for your future and career?
• Describe your interests. • What else do you want your host family to know about you?
• Tell about your friends. What activities do you like to do together? • What would you like to gain from your exchange experience?

Write your letter in English. You may only use both sides of Form 2. Do NOT write outside the box or paste photos on
this form. Do NOT include your family name, your relatives' full names, or the name of your city in this letter. This letter
will be shared with U.S. host families considering hosting you.

Dear American family,

(continue on next page)

 FORM 2 Host Family
YPK-2DM0VX

Letter

STUDENT NAME:
2025-2026
Last name First name Middle name

 FORM 3 Activities and
YPK-2DM0VX

Achievements

2025-2026 STUDENT NAME:

Last name First name Middle name

SECTION 1: List school or other clubs and organizations you belong to. Include sports, scouts, religious or youth groups, volunteering,
social activities, special training or hobbies (such as music, dance, drama, foreign language), and any work experience. Include only those
activities you have been involved in during the last three years; If you are still engaged in the activity write “now”. See the examples
below. Write your activities the same way.

What activities do you participate in?

YEARS OF ACTIVITY
(year start - year end)
ACTIVITY HOW OFTEN If still engaged, write “now”

Example: Basketball 5 hours per week 2023 - now

Example: National dancing lessons Twice per month 2023 - 2024
Example: Cross-country skiing Winter 2023 - now
Example: Volunteering at orphanage Once a month 2022 - now
Example: Writing for the school newspaper During the school year 2022 - 2023

Which activity is your favorite and why?

 FORM 3 Activities and
YPK-2DM0VX

Achievements

2025-2026 STUDENT NAME:

Last name First name Middle name

SECTION 2: Describe how you spend your free time. Explain what you do, why you enjoy it, and with whom you do it. Are there any
activities you are interested in trying in the U.S.? Answer truthfully. Your host family will read this, and may expect you to participate in
these activities in the United States.

SECTION 3: List any awards or prizes you have received and any significant achievements for which you have been recognized. Please indicate
the dates you received the awards or special recognition and the name of the institution giving the award. Examples include prizes, honors,
medals, or Olympiads in areas such as foreign language, creative writing, science, or music.

ACHIEVEMENTS, AWARDS AND LEADERSHIP POSITIONS NAME OF INSTITUTION DATE RECEIVED

Example: City English Language Olympiad School # 140 2023

SECTION 4: If you have traveled on any international exchange program or have lived outside your country, list in this section.

EXCHANGE PROGRAMS (include sponsors) DATES (month & year) CITY, STATE TYPE OF
OR LIVING OUTSIDE YOUR COUNTRY FROM - TO: AND COUNTRY PROGRAM
Example: School Exchange Nov. 2023 - Dec. 2023 Munich, Germany Cultural
 FORM 4 Recommendation
YPK-2DM0VX

From Teacher

2025-2026

STUDENT NAME:
Last name First name Middle name

School city School name

Current class (choose one): 8 9 10 11 12 Other:

INSTRUCTIONS
TO STUDENT: Complete the information at the top of this form. Ask one of your teachers, who knows you well, to complete this form. If you cannot choose a teacher,
you may choose a school director or a teacher from a school you recently attended. This recommendation MUST be filled out in English and returned with your application.

IF THE RECOMMENDER KNOWS ENGLISH: IF THE RECOMMENDER DOES NOT KNOW ENGLISH:
• Give him/her Form 4. • Provide him/her with the instructions and questions translated into the recommender’s native language.
• Ask the recommender to follow the directions below. • Have the recommender’s answers translated into English on to Form 4.
• The translator must complete section 4.9.
• Both the Form 4 and the answers in the local language (if the original is not in English)
must be returned with the application.

TO RECOMMENDER: Please answer the questions and sign this document.Your answers to the questions on this form will be evaluated along with the student’s own
application materials to determine his/her suitability for this scholarship program. Therefore, we ask you to answer each question honestly, carefully and completely. Return
the completed form to the student, who will attach it as part of the application. This form must be filled out in English and have the school stamp.

4.1 Please describe this student’s behavior. How does the student respond to authority? How does he/she relate to peers and participate in group projects with
other students? What talents, interests and skills does this student have that will contribute to an international exchange experience? Please give examples.

4.2 Please comment on the student’s motivation in school and study habits.

4.3 Please evaluate the student’s character in the following categories (check the appropriate boxes):

PERSONALITY TRAITS Excellent Above Average Average Below Average

Maturity
Openness
Leadership
Ability to adapt to new situations
Ability to interact with others
Honesty
Responsibility
Respect for others
Motivation
Curiosity
Knowledge of English (if known)
Comments:
 FORM 4 Recommendation
YPK-2DM0VX

From Teacher

2025-2026

STUDENT NAME:
Last name First name Middle name

4.4a. Has the student had any adjustment or disciplinary problems at school? YES NO

4.4 b. Has the student missed or repeated a year? YES NO

4.4 c. Does the student have a history of continuous or frequent absences from school? YES NO

4.4d. Does the student currently have any special educational needs? For example, are they
excused from certain classes, given extra time on assignments, or other accommodations. YES NO
If you answered “yes” to any question, please explain:

4.5 How long have you known this student? Years:

4.6 In what context do you know this student?

4.7 Are you a teacher at the student’s high school? YES NO If no, explain:

4.8 Check one of the following and explain below:

I feel this applicant is ready to become an exchange student.
I have some reservations about this applicant’s readiness to become an exchange student.
I do not recommend this applicant.

Please explain:

RECOMMENDER
Name of recommender:
last name first name middle name

Position of recommender:

Place of work: Country:

Region: City/Town:

SIGNATURE OF RECOMMENDER: _____________________________________________________________ Date:

TRANSLATOR'S STATEMENT
4.9 This section must be filled out by the translator if the original recommendation is not in English.
I hereby certify that the above English translation is a true and accurate rendering of the original text.

Name of translator:
last name first name middle name

SIGNATURE OF TRANSLATOR: ____________________________________________________________ Date:

 FORM 5 Biographical
YPK-2DM0VX

information

2025-2026 STUDENT NAME:

Last name First name Middle name

STUDENT INFORMATION

Last (Family) name: Country: Postal Code:

First name: Region (if any):

Middle name, if any: District (if any):

Gender (choose one): Male Female Age: City/Town:

Date of birth: Address:

City of birth: Home phone (include city code):

Country of birth: Mobile phone:

Citizenship(s): Other phone number where
If more than one, list all. you can be contacted:

Email: Whose phone is this:

Relationship to you: Friend Relative Other
Are you (or your parents) a U.S. citizen, Have you (or your parents) ever
Yes No Yes No
permanent resident or Green Card holder? applied to emigrate to the U.S.?

FAMILY CONTACT INFORMATION

MOTHER (or legal guardian) FATHER (or legal guardian)

Last name: Last name:

First name: First name:

Work phone (include city code): Work phone (include city code):

Home phone (include city code): Home phone (include city code):

Mobile phone: Mobile phone:

Country: Postal code: Country: Postal code:

Region (if any): Region (if any):

District (if any): District (if any):

City/Town: City/Town:

Address: Address:

Email: Email:

Citizenship(s): Citizenship(s):
If more than one, list all. If more than one, list all.

SCHOOL INFORMATION
School Name/
School city: number:
Class Other:
(choose): 8 9 10 11 12 Address:
School telephone (city code and number): Postal code:
Is this a boarding school at which you live? Yes No
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 FORM 6 Placement
YPK-2DM0VX

Information

2025-2026 STUDENT NAME:

Last name First name Middle name

INSTRUCTIONS
Please fill out this form truthfully and completely. This information is not used during the selection process, so your answers to these questions do
not affect your chances of being selected. Your answers on this form are used only to match you with an American host family if you are selected.

1.0 Describe a typical (normal, not special) day in your life.

1.1 Have you ever been to the U.S.? Yes No If yes, when?

How long did you stay?

1.2 Have you ever lived in or traveled to other countries? Yes No If yes, when and where?

1.3 What are your household responsibilities?

1.4 What time do your parents expect you to be home during the week?

On weekends?

1.5 How much time do you spend on average studying at home each day? hours each day

1.6 Have you ever lived away from home? Yes No If yes, explain below:

1.7 Check the box that best describes the community where you live:  urban  suburban small town rural area

1.8 What is the approximate population of your town/city?

Language Study: 2.0 How many years have you studied English? 2.1 At what age did you begin to study English?

2.2 What language(s) do you speak at school and home?

2.3 What other languages do you know? Please list and indicate your SPEAKING ability in each language.
Language: Years studied: Poor Fair Good Excellent

Language: Years studied: Poor Fair Good Excellent

Language: Years studied: Poor Fair Good Excellent

2.4 Have you ever been excused from taking a class, or had any educational accommodations (for example: excused from a math class due
to a math-related learning disability, or given extra time on tests due to a reading disability)? Yes No If Yes, describe.

3.0 Future Plans: Do you intend to continue your education upon completion of secondary school? Yes No

3.1 If yes, what do you intend to study?

3.2 What are your future job or career plans?

FORM 6 Placement STUDENT YPK-2DM0VX
Information NAME:
last name first name middle name

4.0 About your FAMILY. Who lives in your home? (indicate all that apply)

Father Stepfather Legal Guardian Mother Stepmother Legal Guardian

name age occupation name age occupation

Grandfather name age occupation Grandmother name age occupation

Brothers name age occupation Sisters name age occupation

name age occupation name age occupation

Others name age relationship to you Others name age relationship to you

4.1 Parent(s) is: married separated divorced single widowed legal partners
If divorced/widowed: mother remarried father remarried

4.2 Do you have family members or friends in

the U.S.? Yes No If Yes, explain:

5. What is your religion, if any?

5.1 How often do you currently attend religious services in your home country? once or more a week occasionally never

5.2 Do you need a special place for prayer? Yes No.................................... 6. Can you swim? Yes No

7. Do you have allergies? Yes No *If Yes, please explain

(examples food allergies, grass, pollen, medicines, dogs, cats, etc.):

8. Will you bring any medication or supplements with you? Yes No

*If Yes, please give the name of the medication or supplement and indicate what it is for, how it is taken, etc.

9. Do you have a condition that will require routine medical care or monitoring in the U.S.? Yes No
*If Yes, describe type and frequency:

10. Do you have any dietary restrictions for health, religious, or other reasons? Yes No
If Yes, please explain which foods you cannot or do not eat:

11. Please confirm any answers to questions 7-10 have been added and explained on Form M. Yes No

12. Do you smoke or vape? Yes No 13. Can you live in a home where other people smoke inside the home? Yes No

FOR ALL APPLICANTS: Halal meats (chicken, beef, lamb, etc.) are often expensive and difficult to find in U.S. communities, where most meat is
not slaughtered in compliance with Islamic dietary guidelines. I understand that my family will not expect me to eat pork, but my family is also
SIGNATURE REQUIRED

not required to purchase halal meats (chicken, beef, lamb, etc.) for me. If I prefer not to eat the meat (chicken, beef, lamb, etc.) my host family
provides in case it is not halal, I understand I may need to keep a vegetarian diet while in the U.S.
SIGN
STUDENT SIGNATURE (indicating understanding of this statement)

FOR ALL APPLICANTS: Whether or not you smoke or vape, you will not be allowed to smoke while on the YES program in the U.S. I understand
that there are laws restricting smoking in my host state and host school, and that my host family may have objections to smoking in their home.
I agree to honor these laws and restrictions.
SIGN
STUDENT SIGNATURE (indicating understanding of this statement)

DOUBLE PLACEMENT: By signing this item, my parents or legal guardian and I agree to a host family placement with another high school
IMPORTANT

exchange student. Once the double placement is made my placement organization will provide an update. If I do not sign this statement (which
is optional), my PO may still propose a double placement.
SIGN
LEGAL GUARDIAN SIGNATURE STUDENT SIGNATURE
 FORM 7 Parent-Student
YPK-2DM0VX

Agreement
2025-2026
STUDENT NAME:
Last name First name Middle name

INSTRUCTIONS:
Carefully review this important information with your parents. This form must be signed by you and one of your parents
indicating you agree to the terms and conditions of participating in the program. Return the form to your American Councils
program office with your application. Your parents should keep a copy of this document for their reference.

A. PURPOSE funded by the U.S. Government are required, under Section 212(e)
The Youth Exchange and Study (YES) program (referred to below as of the Immigration and Nationality Act, to reside in their home
“the Program”), sponsored by the U.S. Government, promotes country for a minimum of two (2) years after completing their
friendship between the United States and your country, and provides exchange program in the United States before they are eligible for
participants personal development through living with a U.S. host an immigrant visa, U.S. permanent residence, or a non-immigrant
family and studying in the United States. H or L visa.
7. I understand that if my child is selected to receive a scholarship,
The U.S. Department of State implements the Program with the
final acceptance will depend on fulfillment of the medical,
assistance of private, not-for-profit organizations (referred to as
placement, and academic requirements of the Program, and on
“Program Organizations”). While in the United States, participants are the ability of the placement partner to secure an appropriate
in the care of “Placement Organizations” that identify and arrange family and school placement.
host families and schools and provide support and guidance for
them during the exchange Program. Participants attend a U.S. school, 8. I understand that I may not visit my child during their time on
share in American family life, learn about the United States, increase Program in the United States unless I obtain prior written approval
their sensitivity to cultural differences and similarities, and develop a from the Placement Organization.
deepened awareness of shared human values and interests. The 9. I agree to release and discharge the Program Organizations and
Program, consistent with its commitment to mutual understanding their employees and agents; host families; Program
between the people of the United States and people of other representatives; school representatives; and the U. S. Department
countries, encourages cultural diversity in the selection of of State and its employees, agents, and instrumentalities from any
participants and host families. Participants are required to return to legal liability, claim, or demand in connection with:
their home country after their Program, where they are expected to a. any emergency, accident, illness, injury, or other consequences
share their experiences in the United States. or events arising from the actions or participation of my child
in the Program.
This document must be signed by a natural parent or legal guardian b. any cause, event, or occurrence beyond the control of the
of the participating student (referred to as the “Parent”). Program Organizations or the Department of State, including,
but not limited to, natural disasters, war, terrorism, civil
B. PARENT AGREEMENT disturbances, and the negligence of parties not subject to the
General Program Policies control of the Program Organizations.
1. I give my child permission to participate in this Program. I and my c. any actions or negligence of commercial airlines, trains, buses,
child will obey the policies described in the Program Handbook restaurants, hotels, and other entities engaged for travel-
and Program Organization guidelines. I understand that the related services, including, but not limited to, lost baggage,
original English-language version of this document represents the uncomfortable accommodations, and travel delays.
final authoritative wording of policies and guidelines.
Travel Policies
2. I understand that if I or any other immediate family member has 10. I agree that my child will travel to and from the United States in
applied at any time to emigrate to the United States or if I or any strict accordance with the travel plans made by the Program.
other immediate adult family member (whether estranged or not)
11. I will not encourage or permit my child to travel outside the host
is a U.S. citizen or green card holder, it may negatively affect my
community during participation in the Program except in strict
child’s eligibility for the Program.
accordance with the following requirements:
3. I understand that if another member of my immediate family will a. If my child desires to travel outside the host community with
be living in the United States at the same time my child would be and under the supervision of their host parent(s), school
participating in the Program, it may affect my child’s eligibility for official, or other responsible adult, my child must first obtain
the Program. written approval from the Placement Organization.
4. I affirm that my child has not stayed in the United States for more b. If my child desires to travel outside the host community
than ninety (90) days in total during the past five (5) years. unaccompanied by their host parent(s), school official, or other
5. I understand that my child must meet the Program eligibility responsible adult, my child must first obtain written approval
requirements, be a citizen or permanent resident of the country in from the Placement Organization and me, the child’s Parent.
which s/he is applying, and be able to obtain a passport from Some Placement Organizations may not allow such travel.
their country of citizenship and a J-1 visa for entry into the United c. My child’s safety must be assured to the greatest extent possible.
States. d. The travel must not interfere with school attendance.
6. I understand that participants in an exchange visitor program e. International travel requires prior authorization by the U.S.
 FORM 7 Parent-Student
YPK-2DM0VX

Agreement
2025-2026

Department of State, and the participant must have a multiple- is my responsibility to arrange with the school my child now
entry U.S. visa. attends to receive credit or to take exams upon completion of the
f. I understand that many Placement Organizations limit, Program; or to arrange for permission for academic absence from
discourage, or do not allow visits with natural family members any institute or university to be attended upon return.
or friends from the home country even if they live in the United 17. I understand that my child must attend school and complete
States. Such visits interrupt the continuity of the relationship required coursework. Non-attendance may result in dismissal
with the host family and may diminish the exchange from the Program. Allowing for an initial period of adjustment,
experience for the student and host family. Policies vary by participants must achieve and maintain adequate academic
Placement Organization. I agree to follow all Placement results. After a reasonable period of time, poor motivation, under-
Organization’s rules concerning visits. achievement, or inappropriate behavior may be cause for
g. I understand that visits to my child’s home country while on dismissal from the Program. If a student is expelled from school, it
program are not allowed. Exceptions may be made in the case will likely result in Program dismissal.
of the death or imminent death of an immediate family member
18. I am aware that the United States is a multi-racial, multi-ethnic
(mother, father, brother, sister) contingent upon identification of
country providing a diversity of living experiences and that there
funding to cover the costs and Program approval. An
is no single living experience that is typical. I understand that
unauthorized visit will result in my child’s dismissal from the
placements are made based on criteria designed to determine
Program. Such non-emergency trips break the continuity of the
suitability of host families, and the Program does not discriminate
relationship with the host family and may diminish the
on the basis of race, disability, religion, gender, or ethnic origin,
exchange experience for the student and host family. Any
with respect to either participants or host families.
requests for exceptions must be presented to the Placement
Organization and approved by the U.S. Department of State. 19. I understand that participants and parents cannot choose host
12. I understand that my child will be responsible for paying any fees families, school, grade placement, or location of placement.
incurred for carrying baggage in excess of the baggage limits set Placement organizations will request participant and parent
by the airlines used for Program travel. I understand that this agreement if your child will be 1) placed in a home with another
provision applies to both international and domestic travel within exchange student [a double placement]; 2) placed with a single
both the United States and our country. host parent without children in the home; or 3) enrolled in a
school run by a religious organization. I understand that if I or my
13. I understand that in making travel arrangements for my child, the
child decline a valid placement, my child may be disqualified from
Program Organizations contract with or use commercial airlines,
trains, buses, restaurants, hotels, and other entities whose the program.
performance and services cannot be controlled by the Program. I 20. I understand that my child cannot be hosted by our family
agree that the Program Organizations reserve the right to change members.
or alter travel, lodging, or other arrangements if they believe such 21. I understand there are strict laws restricting smoking and vaping
change or alteration to be in the best interest of the participants. by people under the age of 21 in the United States. I understand
14. I understand that my child must return home at the end of the that the host family may have objections to smoking and vaping
Program on the date assigned by the Program Organization. in their home and that schools forbid smoking and vaping or the
Participants will not be allowed to remain in the United States possession of tobacco and e-cigarette products. I and my child
after their assigned return-travel date. After which time, they will agree to honor all U.S. laws and host family, school, and
no longer be supported by the Program, will not have health Placement Organization restrictions.
benefits, and may be reported to the U.S. Department of
Health/Medical Issues
Homeland Security. Changes to the assigned departure date will
22. I understand that before a participant arrives in the United
not be made to accommodate graduation, prom, or other special
States, the Program must receive written permission from
school or family events that occur after the assigned date.
Parents to obtain emergency medical attention if needed (see
School and Host Family Placement Permission for Care of My Child). My child will receive medical
15. I authorize the Placement Organizations and their employees and attention in case of an accident or emergency. The insurance
representatives to change the place of residence or school provider is determined by each Placement Organization. Each
designated for my child when they believe such change to be in insurance provider has specific policies and restrictions
our child’s best interest. I understand that I will be notified of any governing the types of expenses it will reimburse. Placement
such changes. Organizations, their representatives and host families are not
16. I recognize that schools in the United States may impose responsible for any medical bills not covered by insurance
academic standards or other requirements in determining grade regardless of who signs the hospital admission form. The
level placement that differ from those at the school my child now Program is not responsible for any negative results because of
attends. I acknowledge and accept that participation in the medical treatment.
Program does not guarantee credit or graduation from the school 23. I confirm the information stated in the Student Health Certificate is
my child now attends or from the U.S. school my child will attend accurate and contains no material omissions of which I am aware.
while participating in the Program. I and my child will accept the I understand that omitting information on the Student Health
grade placement assigned by the U.S. school. I understand that it Certificate could endanger the health of my child and may be
 FORM 7 Parent-Student
YPK-2DM0VX

Agreement
2025-2026

grounds for dismissal from the Program. I will immediately • windsurfing (operation or passenger of)
inform the Program Organization of any change in information. I • snowmobiling • skateboarding
understand that any physical or mental health condition requiring (operation or passenger of) • snowboarding
a significant and sustained level of care or monitoring of my child • spelunking • BMX racing
may require reconsideration of my child’s participation in the • motorcycle/motor scooter • X-games
Program. In the event my child has a recurrence of any previous riding (extreme sports)
illness or any condition contracted before leaving home or in the
United States that is not covered by insurance provided by the Participants are not permitted to engage in any activities not
Program, I authorize the Program Organization to release my child covered by a health benefit plan or insurance. In addition,
to my care in our home country. I will not hold the Program participants are not permitted to engage in any activities
Organizations and their employees and agents; host families; prohibited by their Placement Organization even if the activity is
Program representatives; school representatives; or the U.S. covered by insurance.
Department of State and its employees, agents, and 28. Driving Motorized Vehicles: Participants are not permitted to
instrumentalities responsible for any debts incurred in connection drive any motorized vehicle (such as a car, motorcycle, all-terrain
with this permission. I understand that treatment will be provided vehicle, etc.) or pilot any aircraft under any circumstances while
for injuries sustained by my child while on Program, but the extent in the United States. Violators of this policy will be considered for
of coverage is subject to the Program’s insurance or health benefits Program dismissal. Exceptions may be granted for farm
providers’ rules and policies. equipment if allowed by the participant’s Parent and Placement
24. I confirm I have provided a full and complete medical and Organization. If authorized, the participant must observe
immunization history for my child. I understand that U.S. schools precautions regarding safety and legal limitations.
require immunizations and I agree to allow the Program 29. Employment: The J-1 visa status permitting participants to stay in
Organizations to arrange for all immunizations required for my the United States restricts employment. Participants may not be
child. I understand that such immunizations will be administered employed on either a full or part-time basis but may accept
according to U.S. medical standards and at no expense to me or informal employment such as babysitting or yard work.
my child. 30. Marriage and Pregnancy: Participants who marry either while a
25. I agree to and authorize the Placement Organization, its personnel participant or prior to the becoming a participant will be
and representatives, and the adult members of the host family, to considered for dismissal from the Program. Participants who are
act for me in any emergency, accident, or illness. discovered to be pregnant or to have caused a pregnancy must
return home.
GENERAL POLICIES 31. Participant Expenses: The Program provides orientations, travel
26. Internet: Participants are required to follow all rules regarding arrangements, host family and school placements, allowances,
use of computers, tablets, cell phones, and the Internet as and insurance. In addition, the Program provides the Form
determined by their Placement Organization, host family, and/or DS-2019 required to apply for a J-1 visa at a U.S. embassy or
host school. Participants who place private (contact information, consulate. The Program is not responsible for additional student
pictures, etc.) or other information on the Internet in violation of expenses beyond the incidentals allowance, monthly pocket
the rules established by their Placement Organization, host family, allowance, and official Program activities and travel. The host
and/or host school may be dismissed from the Program. These family is responsible for providing three meals a day for the
Placement Organization rules are intended to protect students’ participant and must provide either lunch money or a bag lunch.
safety. Students who in any way put the safety of themselves or All other expenses, such as extra school fees or activities, social
others at risk by misusing the Internet may be dismissed from the activities, personal and hygienic supplies, postage, and telephone
Program and may be subject to prosecution for any violation of calls, are paid by the participant using Program allowances.
law. 32. Illegal Activity: Students may be subject to prosecution by the
27. Dangerous/Risky Activities: All health benefit or insurance plans U.S. legal system and may be dismissed from the program if they
consider certain activities risky and will not cover treatment for engage in illegal activity, including but not limited to:
injuries sustained while participating in them. Such activities may • Alcohol: Participants are required to observe all U.S. laws with
include, but are not limited to, the following: regard to the minimum drinking age in the United States,
which is 21.
• boxing • downhill skiing
• Drugs: Participants are prohibited from selling, using,
• bungee jumping • horseback riding
distributing, sharing, or possessing any drugs that are illegal
• scuba diving • parachuting
under federal, state, or local law, including, but not limited to,
• skydiving • zip lining
marijuana and unauthorized use of prescription drugs. Any
• rock climbing (indoor/outdoor) • parasailing
infraction is considered a grave violation of policy and may
• hang gliding • water skiing
result in dismissal from the program.
• operation or passenger of an • wakeboard riding
• Smoking: There are strict laws restricting smoking in the
all-terrain vehicle (ATV) or • jet skiing
(operation or passenger of) United States. The legal age to buy tobacco in the United
motocross bike
States is 21 years old. According to the Food and Drug
 FORM 7 Parent-Student
YPK-2DM0VX

Agreement
2025-2026

Administration (FDA), tobacco includes cigarettes, smokeless child, while in the United States, does any of the following, then it
tobacco, hookah tobacco, cigars, pipe tobacco, electronic may be determined that my child has voluntarily withdrawn from
nicotine delivery systems including e-cigarettes (vapes) and the Program:
e-liquids. a. is absent without authorization from the host school or the
• Theft or shoplifting place of residence designated by the Placement Organization
• Any other activity that is against U.S. law or that results in without obtaining the advance written approval of the
the participant being arrested or charged with a crime. Program. The Program may determine that the student has
left the Program through their own voluntary action. In this
Neither the Program Organizations nor the Department of State is case, the Program is absolved from all obligations, legal or
obligated to provide legal counsel or defray representation otherwise, to the student or their Parents for the student’s
expenses or fines of any sort should a participant be charged current or future well-being. The Program will, if the
with any crime or do something that attracts the attention of law circumstances warrant, work with the student to return to the
enforcement officials. In such cases, the participant is subject to Program. However, if this cannot be accomplished, a decision
all local, state, and federal laws. will be made that the separation from the Program is final,
and the student will receive a letter from the Program sponsor
TERMINATION FROM THE PROGRAM indicating that the student has been reported to the U.S.
33. I understand that my child may be dismissed from the program Department of Homeland Security in the Student and
for behavior that the Program Organizations, with the Exchange Visitor Information System (SEVIS) database. The
concurrence of the U.S. Department of State, consider participant’s medical insurance and health benefits will be
inappropriate or detrimental to my child or to the program. canceled; or
Inappropriate or detrimental behavior may include, but is not b. travels without their Placement Organizations authorization;
limited to, violating host family or school rules, academic under- or
performance, or failure to participate in program activities. It may c. has misrepresented themselves in the Program application.
also include inappropriate sexual behavior, including but not 35. If my child voluntarily withdraws or is dismissed from the
limited to the viewing and/or sharing of sexually explicit material, Program at any time after departure from our country, I
verbal or physical harassment, and any violation of U.S. law. understand that their scholarship, Program status as a J-visa
34. I agree that if I violate any provision of this Agreement, or if my holder, and health insurance/benefits coverage will be canceled.

C. NATURAL PARENT DECLARATION AND AGREEMENT

I have discussed the Program and this Agreement with my child, and each of us fully understands the obligations imposed on us.
I confirm that all information provided in my child’s application materials and this Agreement is truthful. We understand that any
misrepresentation or false answer in this application can be grounds for my child’s termination from the Program.

PARENT/LEGAL GUARDIAN SIGNATURE DATE

Printed name:
Last name First name Middle name

D. STUDENT DECLARATION AND AGREEMENT

I have read this Agreement and discussed with my parent(s) or guardians its terms and conditions. I agree with the purpose of the
Program and fully accept all terms and conditions of this Agreement, and all other rules, regulations and conditions set forth
concerning the Program. In particular I will do my best to become an integral part of my host family, school and community; will
travel only in accordance with the Travel Policies Section of this Agreement; and will attend the school designated for me on a
regular basis and complete all work to the best of my ability. I hereby certify that the information provided in all parts of this
application is truthful. I understand that any misrepresentation or false answer can be grounds for my dismissal from this Program.

STUDENT SIGNATURE DATE

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 FORM 9
YPK-2DM0VX Privacy
Policy
Statement

2025-2026 STUDENT NAME:

Last name First name Middle name

Privacy Information about candidates and participants of programs is required for American Councils for International Education: ACTR/ACCELS, AFS
Intercultural Programs, iEARN, AMIDEAST, and IRIS (YES program organizations) to administer the programs, to evaluate their quality and effectiveness,
as well as to develop new projects.
American Councils firmly adheres to the principle of confidentiality of information received from program candidates and participants and uses the
information in accordance with this Privacy Policy Statement. The principles stated herein are binding only on American Councils; other organizations
involved in the administration of these programs may adhere to other privacy or similar policies.

1. CONTENT AND MEANS OF COMPILING INFORMATION

Information about program candidates and past and current participants consists of data contained in their applications, information derived from
interviews with them, as well as information gathered in the course of the program relating to the administration of the program and academic
achievement. This information, in addition to contact information, education, professional experience and information on the place and nature of work,
and position of participants may also include other personal information.
American Councils stores this information in written and electronic form. Some information, such as contact information is continually updated so that
representatives of YES program organizations can remain in contact with program participants in order to offer supplemental information about new
programs and projects as well as to obtain the participants’ evaluation of the effectiveness of programs.

2. USE OF INFORMATION
Information, which is compiled as described above, may be:
• Used by qualified selection committees and interviewers to review the candidacy of applicants to the program;
• Supplied to the program’s funding organization;
• Submitted to potential host schools, universities, or hosting organizations and/or organizations which provide internship opportunities to arrange
placement in an academic, training, or internship program or a host family;
• Used for the evaluation of an individual’s participation in the program and adherence to norms and rules established by the program;
• Used for notifying past program participants of upcoming events and about new programs and projects they may participate in;
• Used in the collection of data for program evaluation purposes;
• Provided to funding agencies or organizations contracted by American Councils to conduct program evaluations;
• Provided to participants and alumni of this and other U.S. government–sponsored programs for the purpose of fostering alumni networking;
• Provided to non-commercial organizations for the purposes promoting professional development among program alumni.

Information about individuals—program candidates and participants—may also be used by American Councils, funding agencies, and their
representatives for the purpose of statistical and evaluative research of the programs. Information analyzed for these purposes may be published only
as aggregate statistical data. Personal data are not subject to publication, except for contact information and information related to the U.S. academic
or professional program (such as placement location: school, university, etc., or hosting organization; field of study and research topic), to subsequent
involvement in alumni programming (such as participation in events for alumni and the small grant programs) as well as information provided to YES
program organizations by the participant or alumnus/na (unless the participant or alumnus/na expressly prohibits publication of said material).

STUDENT City of residence:

NAME: Last name First name Middle name
Country of residence:

STUDENT SIGNATURE DATE

I hereby agree to the terms of the collection, use, updating (changing, renewal), cross-border sending and retention (and any and all other uses as
stipulated in Forms 1-11) of the personal information in this application, additionally including the processing of special personal information dealing
with religious persuasion, health condition, and personal and family life, concerning my son/daughter with the purpose, covered in the Privacy Policy
Statement, of using the information for the period of the program, for statistical and evaluation purposes of the program. This agreement can be
rescinded by me in writing.
STUDENT’S
PARENT
OR LEGAL
GUARDIAN: Last name First name Middle name

PARENT OR LEGAL GUARDIAN SIGNATURE DATE

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 FORM 10 Permission for
YPK-2DM0VX

Care Of My Child

2025-2026

STUDENT INFORMATION

STUDENT NAME:
Last name First name Middle name

DATE OF BIRTH: SEX (select one): Male Female

Fill out the information in the lines above. Have your parent or legal guardian sign the statement for permission
for care. Return this document as part of your completed application by the due date shown on FORM 1.

PERMISSION FOR CARE (statement to be signed by your parent)

My child has my permission to take part in the CBYX/FLEX/YES secondary school exchange program. As
the applicant’s parent or legal guardian, I authorize the respective adult representatives of the Program
Organizations and their employees and agents; host families; Program representatives; school
representatives; and the U.S. Department of State and its employees, agents, and instrumentalities, to act
for me in any emergency, accident, physical or mental illness, or need for immunization. I will not hold
these organizations responsible for the results of any treatment in said emergency, accident, physical or
mental illness, or need for immunization. I will not hold these organizations responsible for any debts
incurred in connection with this permission.

In the event that my child has a recurrence of any previous physical or mental illness or condition
contracted before leaving home, I, the undersigned, authorize the program implementer to return my child
to my care.

I give permission to the physician selected by the program to order x-rays, routine tests, and physical or
mental health treatment related to the health of my child for both routine healthcare and in emergency
situations. I give my permission to the physician to hospitalize, secure proper treatment for, and order
injection, anesthesia, or emergency surgery for my child. I also understand that American Councils will
make every effort to contact me in any such case.

I agree that providers who treat my child may release medical or other legal records of my son/daughter
in the United States to program representatives, including the U.S. Department of State, American
Councils for International Education, the U.S. placement organization, Mobility International USA, and/or
the U.S. host family, and may talk to program representatives about my child’s physical and mental health
status. I give permission to photocopy this form.

Printed name of
PARENT/LEGAL GUARDIAN:
Last name First name Middle name

Relationship to student:

PARENT OR LEGAL GUARDIAN SIGNATURE DATE

 FORM 11
YPK-2DM0VX Participant
Consent and
Release Form

2025-2026

STUDENT NAME:
Last name First name Middle name

In connection with the Kennedy– Lugar Youth Exchange and Study (YES) program, I hereby authorize
the U.S. Department of State and its program implementing partners to photograph, film, or otherwise
record and use my image and/or voice in connection with related public information programs and
activities.

Additionally, I hereby authorize the U.S. Department of State and its implementing partners to release,
publish, or quote such material, including my name, in connection with related public information
programs and activities.

With respect to this material, I understand that content may be included in future speeches, on the
Internet, and through multiple broadcast channels and print media (which may include use by U.S.
Embassies abroad to promote U.S. Department of State exchange programs and public diplomacy
efforts) but that such content will not be used for commercial purposes.

I understand that I may decline to give my consent and still continue to participate in all exchange
program activities without being disadvantaged with respect to those activities.

PARTICIPANT SIGNATURE DATE

Printed name:
Last name First name Middle name

Email address:

City of residence:

Country of residence:

As a YES program participant, I grant the above consents and authorizations. YES NO

As the parent or legal guardian of the YES program participant, I grant the
above consents and authorizations on behalf of my minor child or ward. YES NO

PARENT/LEGAL GUARDIAN SIGNATURE DATE

Printed name:
Last name First name Middle name

Email address:
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YPK-2DM0VX
 YPK-2DM0VX

Important Instruc�ons

Atach the following documents with filled YES-2025-26 applica�on.

• Photocopies of last three-years mark sheets. Make sure the mark sheets MUST be atested
by your current school (stamped and signed by the school official).

1. Final mark sheet of academic year 2021-22

2. Final mark sheet of academic year 2022-23
3. Final mark sheet of academic year 2023-24 (if the final exams result hasn’t been
announced, atach the last school-based mark sheet).

(Note for Cambridge students: they will have to submit the final mocks results
having all the core subjects men�oned in the criteria instead of your Cambridge
result.)

• Photocopy of NADRA’s Bay form / Smart card / FRC (anyone of them)

Make sure the photocopies are clear and readable. Blur or dark photocopies will not be
considered. Also make sure the photocopies of your marksheets are complete. Incomplete
photocopies of mark sheets will not be considered.
When the YES-2025-26 applica�on is ready. Courier/post the duly filled applica�on with required
documents to the following address.

YES-2025-26 Applica�on
Society for Interna�onal Educa�on
88-H, P.E.C.H.S. Block-6,
Karachi 75400.
Tel: 0333-2929960

APPLICATIONS WILL ONLY BE ACCEPTED THROUGH COURIER/POSTAL SERVICES.

Last date of receiving YES-2025-26 Applica�on is October 21, 2024

Important Note:

Providing any false/forged documents, information or any discrepancy

found at any stage of selection process will result in disqualification of the
applicant.