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Candidate Application (Ms.)(Mr.) First name Middle name Last name Birthdate: day/month(spell word)/year Home city Home state/province Home country AFS sending organization For office use only AFS ID# Program applying for Elijah Daniel Batislaong Geanga 27 May 1996 Puerto Princesa Palawan Philippines PHI AT TA CH PHOTO HERE

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Page 1: AFS Application

Candidate Application

(Ms.)(Mr.) First name Middle name Last name Birthdate: day/month(spell word)/year

Home city Home state/province Home country AFS sending organization

For office use only

AFS ID# Program applying for

Elijah Daniel Batislaong Geanga 27 May 1996

Puerto Princesa Palawan Philippines PHI

AT TA CH PHOTO HERE

Page 2: AFS Application

1 Basic Personal Information AFS ID#

1 CANDIDATES LEGAL NAME

(Ms.)(Mr.) First name Middle name Last name Preferred name/nickname2 ADDRESS FOR MAILING PURPOSES

Street/P.O.

Updated Aug 2008

Box Zip/Postal Code

City & State/Province Country

Telephone Mobile Phone Email addressFax Birthdate: day month (spell word) year

3 FOR VISA PURPOSES

City of Birth Country of Birth

Country of Citizenship Country of Legal Residence

Passport Number (if known) Passport Issue Date

Place/Office of Passport Issue Passport Expiration Date

INFORMATION ABOUT THE PEOPLE WITH WHOM I LIVEI live with: Father Mother Stepfather Stepmother Guardian Other than ParentWho is your custodial parent? Please circle. (If more than one, circle both).For Adult Programs - Additional options: Spouse Independent Other

5

4

INFORMATION ABOUT PARENT (S)/GUARDIAN(S) WITH WHOM I LIVEParent/Guardian Male Female

Male Female

Legal name: First Name Last Name Business and/or Mobile Phone

Date of Birth Country of Birth Occupation Employer EmailParent/Guardian

Legal name: First Name Last Name Business and/or Mobile Phone

Date of Birth Country of Birth Occupation Employer Email6 CONTACT DETAILS OF ANY NATURAL PARENT WITH WHOM I DO NOT LIVE

Legal name: First Name Last Name Business and/or Mobile Phone

Date of Birth Country of Birth Occupation Employer Email

Address7 EMERGENCY CONTACT

If your Parent/Guardian cannot be reached, please indicate someone else in your community whom we can contact:

First Name Last Name Relationship Telephone Numbers (home, work, mobile)8 NAMES AND BIRTHDATES OF BROTHERS AND SISTERS

9 AFS CONNECTIONS

Has your family: (If yes, please describe who, the relationship, where and when.)Hosted on AFS? Yes NoParticipated on an AFS program? Yes NoAny close friends or relatives living abroad? Yes NoHave you participated in any other exchange program, traveled abroad or lived in another country? Please provide details.

Have and name of the sponsoring institution.

you ever traveled to the United States on a F-1 or J-1 Visa? Yes No (If yes, please indicate wich type of visa and

FOR OFFICE USE

Page 3: AFS Application

2 Placement Information AFS ID#

1 CANDIDATE NAME

(Ms.) (Mr.) First name Middle name Last name Home country

2 MEDICAL REQUIREMENTS AND HEALTH RESTRICTIONS

Do you have physical restrictions, impairments or allergies that will limit placement options or participation in everydayfamily and/or school activities? Yes No If yes, please explain:

Please

If you have checked that you CANNOT live with a pet, please indicate why: Allergy Fear Religion

check the appropriate boxes if you CANNOT live with: Cats Indoors? Outdoors? Dogs Indoors? Outdoors? Other pets Indoors? Outdoors? If you checked boxes for other pets, please explain:

3 DIETARY REQUIREMENTS

Do you have dietary restrictions, including for medical, religious or self-imposed reasons? Yes No If yes, please explain:If you are a vegetarian, are you willing to eat: Fish Poultry Dairy products

4 RELIGION

What is your religious affiliation, if any? (Optional)How often do you participate in structured religious services? Weekly Monthly Occasionally NeverBearing in mind that it is likely your host family will have different religious affiliation, how strongly do you feel abouthaving access to structured religious services of your own faith? Required Not necessary

5 SMOKINGDo you smoke cigarettes? Yes No In some cultures it is more difficult to find placements for cigarette smokers.Given this, smokers should please choose one of the following: I will / I will not smoke during my AFS exchange program

6 LANGUAGES

Native languageLanguage proficiency (for languages other than your native language):

Language Years studied Speaking ability: Poor Fair Good Excellent

Language Years studied Speaking ability: Poor Fair Good Excellent

Language Years studied Speaking ability: Poor Fair Good Excellent

DISCLAIMER

I

I further understand that I may not be eligible to participate in athletic teams related to my host school or community.

understand that host countries may not be able to accommodate the restrictions or requirements indicated in the completed application and that acceptance on the AFS program is not a guarantee that these preferences can be honored.

Candidate Signature Date

Parent/Guardian Signature Date (Parent/Guardian signature is required for all secondary school programs and candidates not of legal age in country of residence.)

FOR OFFICE USE

Other(explain)

Updated Aug 2008

Page 4: AFS Application

3a Health Certificate AFS ID#

To be completed and signed by the candidate’s physician. The physician should not be related to the candidate. Eachquestion must be answered with a detailed explanation included or attached in a separate report for “YES” responses toquestions 3-9, 11-13. AFS reserves the right to ask for further information and determine if the candidate meets the pro-gram medical qualifications. The candidate and parent/guardian must also sign.

(Ms.) (Mr.) Candidate Name (First/Middle/Last) Home Country Birthdate

1 Height Weight B/P Pulse Respiration Blood Type

2 Do you note any abnormalities concerning height, weight (including substantial loss or gain in the past six months), bloodpressure, pulse or respiration? Yes No If yes, explain

3 CHECK YES OR NO. HAS THE CANDIDATE HAD THE DISEASES / CONDITIONS LISTED BELOW:YES NO

YES NO YES NO

YES NOIF KNOWN:a) Measles Titer: Date: h) Rheumatic Fever

b) Mumps Titer: Date: i) Cough (persistent, recurring)

c) Rubella Titer: Date: j) Headaches (persistent, recurring)

d) Chicken Pox k) Sleepwalking

e) Poliomyelitis l) Enuresis

f) Hepatitis m) Appendicitis

g) Tuberculosis n) Parasites (internal)

If yes, give detailed information and dates (use extra pages if necessary):

4 ACNE Yes No If

If yes, month/year:

yes, identify area, severity, any medication taken, name, dosage & frequency:

5 ALLERGIES Yes No If yes, identify type, any medication taken, name dosage & frequency:

6 ASTHMA Yes No If yes, identify type, severity, any medication taken, name, dosage & frequency:

7 DIABETES Yes No If yes, identify type, severity, any medication taken, name, dosage & frequency:

8 SEIZURE DISORDER

Yes No If yes, identify type, severity, any medication taken, name, dosage & frequency:

9 HAS THE CANDIDATE EVER HAD ANY DISEASE, IMPAIRMENT OR ABNORMALI TY OF:

a) Abdominal organs, digestive system e) Heart blood vessels

b) Lungs, respiratory system f) Tonsils nose or throat

c) Bones, joints, locomotor system g) Blood, endocrine system

d) Genito-urinary system h) Eyes/vision, ear/hearing

If yes, please explain (use extra pages, if necessary )

10 HAS THE CANDIDATE BEEN HOSPITALIZED? Yes No If yes, give dates, diagnosis and outcome for each incident.

FOR OFFICE USE

Updated Aug 2008

Page 5: AFS Application

3b Health Certificate AFS ID#

Candidate Name (First/Middle/Last) Home Country

11 Is the candidate currently taking medication or injections (other than those mentioned previously)? � Yes � NoIf yes, identify the medication, reason for usage, dosage and frequency:

12 Has the candidate EVER consulted a neurologist, psychologist or any other specialist for a nervous, emotional or eat-ing disorder? � Yes � No

13 Is there a history of, or present evidence of, an emotional, nervous or eating disorder? � Yes � No If yes to either (12 or 13), a FULL report by the specialist and a statement by the candidate about the illness or specificproblem must be attached in a sealed envelope. Note: Placement in a foreign host family, school and communityrequires adjustment which often involves emotional stress. It will not be a time for relaxation or temporary relief fromany current therapy. If the candidate is experiencing current emotional, physical, personal or family difficulties, thesedifficulties can be severely exacerbated by the adjustment demands of the AFS program. Therefore, you are requestedto evaluate carefully the candidate’s current or previous condition and treatment along with his or her ability to man-age potential adjustment anxieties and stress in a foreign environment.

14 Are there any health limitations or restrictions on the candidate’s activities and / or sports participation or any medicalinformation which should be considered for a home/school placement? � Yes � No If yes, please describe:

15 Does the candidate wear glasses or contact lenses? � Yes � No

16 What was the date of the candidate’s last dental check up?

Does the candidate wear dental braces? � Yes � No

If yes, will orthodontic care be needed while on the program? � Yes � No Frequency?

17 CANDIDATE HAS HAD THE FOLLOWING IMMUNIZATIONS, PLEASE SPECIFY EXACT DAY, MONTH ANDYEAR:

YES DAY/MO/YR DAY/MO/YR DAY/MO/YR DAY/MO/YR DAY/MO/YRMeasles �

Mumps �

Rubella �

Diptheria �

Pertussis �

Tetanus �

Poliomyelitis �

BCG �

Hepatitis B �

Other �

TB Test Which type (circle one) Mantoux or Tine Date: Result (+/-)If positive, was chest x-ray done? � Yes � No Date: Result (+/-)

I, the undersigned, certify that a thorough physical examination of the candidate has been given and all importantrecent medical information has been included on Form 3A and 3B, that nothing relevant has been omitted, and that thecandidate is able to travel. I understand that the omission of any information could be harmful to the candidate’shealth care and could result in early termination from the AFS program.

Physician Name and Degree Signature

Address Date

Your signature below attests that you understand and accept the AFS Medical Policies as stated on the ParticipationAgreement, that the information on Form 3A and 3B is correct and complete and that inaccurate or incomplete infor-mation could be harmful to the candidate’s health care and could result in early termination from the AFS program.

Candidate Signature: Date:

Parent/Legal Guardian Signature: Date:

FOR OFFICE USE

Page 6: AFS Application

4 Introduction to Your Host Family AFS ID#

Candidate Name (First/Middle/Last) Home City Home State/Province Home Country

Just as you are curious about your host family, they will be curious about you. Here is a chance to provide them with afeeling for who you are.

PHOTO PAGE

To help you introduce yourself to a host family, assemble a small collection of photographs showing you, your family andfriends. Be creative!

Place the photos, with a short phrase to describe the photo, on a single sheet of paper (either A4 or 8 1/2 x 11 inch). Printyour name and your country of origin on the Photo Page and on the back of each photo. If possible, make a color copy ofthis page; this will make it easier for AFS to send overseas and you can keep the original.

LETTER TO HOST FAMILY

INTERESTS AND ACTIVITES

This is your chance to tell your prospective host family about yourself in a letter. Incorporate your answers to the ques-tions below in order to communicate who you are and your motivation for going abroad with AFS. Please do not use thename of country in which you may be interested. Please write your letter in English, even if you submit a second letter ina second language.

Your letter should be approximately two pages long. Keep in mind that this will be the first impression your host familyhas of you. Therefore, type or print legibly in black ink. Please include your letter with this form. Please answer the following questions in the body of your letter.

1 How would your family and friends describe your personality?

2 How would you describe your relationship with your family and friends? For example, how are you different fromyour brother/sisters and/or friends? What is your role in the family? In what types of situations do you seek advicefrom your parents?

3

What are your different roles in your community (For example: school, sports, community activities)? What is important to you?

4

What was your motivation to apply for the AFS program? What are your personal goals for the program?5

What part of your daily life do you find frustrating or difficult?6

Whether or not you have been successful, please describe an obstacle in your life and how you attempted to overcomethis challenge.

7

What 8

Describe in more detail for your host family your major interests and activities and how often you pursue them.

Please identify for your host family your major interests and activities.

are your future education or career plans?

FOR OFFICE USE

Updated Aug 2008

Page 7: AFS Application

5 Parents Statement AFS ID#

Candidate Name (First/Middle/Last) Home Country

Please provide a brief statement about your son/daughter covering his/her:

1 Relationship with you and your family.

2 Relationship with others.

3 Reactions to disagreement and discipline.

4 What is the amount of independence given to your child?

5 How does your child handle challenging or difficult situations?

6 Reactions to being away from home in the past. Please also discuss any factors (e.g., dietary, physical, or health limitations) which you believe should be considered in placing your child in a new environment.

Please use a computer (and paper clip your print-out to this form), type or print legibly in black ink.

Parent/Legal Guardian’s Signature Date

FOR OFFICE USE

Updated Aug 2008

Page 8: AFS Application

Self Permission Form PL ID#

Name of participant Date

AFS Program of participation

PERMISSION TO USE PHOTOGRAPHS AND VIDEO FOOTAGEI understand that photographs and film and video footage (the “images”) of current and former participants are occasionally used by AFS in promotional materials. By signing this Agreement, I grant to AFS the right to use, publishand/or reproduce for any lawful and legitimate purpose excerpts from interviews and letters, images and audio record-ings and any other still or moving images of me taken during my involvement with AFS and to use my name in this con-nection. I understand that if I do not wish my images to be so used, I must mark the following box and initial the spacebeside it. By leaving this box blank, I understand that I will be deemed to have consented to such use.

Initial here if you DO NOT give permission for AFS to use such letters, images and audio recordings of yourself.

AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENTShould any medical emergency arise, if time permits, AFS will communicate with the person(s) I have designated below as the emergency contact(s) through the National Office and request permission for surgery or other necessary treatment;however, if in the sole judgment of AFS, time and circumstances do not permit communication with them, I authorize AFS to consent to medical treatment, the administration of x-ray examination, anesthetics, blood transfusion, medical or surgical diagnosis or treatment and hospital care and to make medical evacuation arrangements and transport, if required,which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and surgeon.

I am aware that some local government may require certain vaccinations in order for myself to participate in communityresponsibilities. I understand that I am responsible for any costs related to these requirements.

AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATIONI hereby authorize AFS, and/or its duly authorized medical consultant, to obtain all medical records relating to examinations or treatments for me while I am on the program and any other information concerning such examinations or treatments.

AGREED AND ACCEPTED:

Signature of participant

Participant’s Birthdate: day month (spell word) year

Name of emergency contact Relationship

Work phone Home phone

Address

Page 9: AFS Application

6 Parental Authorization Form AFS ID#

Candidate Name (First/Middle/Last) Home Country Date

PERMISSION TO USE PHOTOGRAPHS AND VIDEO FOOTAGE

We understand that photographs and film and video footage (the images) of current and former candidates are occasional-ly used by AFS in promotional materials. By signing this Agreement, we grant to AFS the right to use, publish and/orreproduce for any lawful and legitimate purpose excerpts from interviews and letters, images and audio recordings andany other still or moving images of the candidate taken during his/her involvement with AFS and to use his/her name inthis connection. We understand that if we do not wish the candidate’s images to be so used, we must mark the followingbox and initial the space beside it. By leaving this box blank, we understand that we will be deemed to have consented tosuch use.

AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENTShould any medical emergency arise, if time permits, AFS will communicate with us through the National Office andrequest permission for surgery or other necessary treatment; however, if in the sole judgment of AFS, time and circum-stances do not permit communication with us, we authorize AFS to consent to medical treatment, the administration of x-ray examination, anesthetics, blood transfusion, medical or surgical diagnosis or treatment and hospital care and to makemedical evacuation arrangements and transport, if required, which is deemed advisable by, and is to be rendered underthe general or special supervision of any physician and surgeon.

We are aware that some local government or school authorities may require certain vaccinations in order for our child toparticipate in school or community responsibilities. We understand that we are responsible for any costs related to theserequirements.

AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION

We hereby authorize AFS, and/or its duly authorized medical consultant, to obtain all medical records relating to examinations or treatments for our son/daughter while on the program and any other information concerning such examinations or treatments.

PERMISSION FOR SCHOOL SPONSORED ACTIVITIES (FOR SCHOOL-BASED PROGRAMS ONLY)We authorize the AFS host parents for my son/daughter during his/her participation in the AFS program to execute anyauthorization required by our son/daughter’s school for our son/daughter to participate in any school sponsored activities, events or programs.

SCHOOL COMMITMENT (FOR SCHOOL-BASED PROGRAMS ONLY)

The student fully understands that this AFS program is school-based and family-oriented. The student intends to partici-pate fully in school activities and to complete all assignments and schoolwork while on exchange. We understand thatschool is compulsory. If the student should neglect the above, AFS and/or the host school has the right to deny his/her participation in classes and s/he may be sent home.

AGREED AND ACCEPTED BY

(Signature of Natural Parent)

(Signature of Natural Parent)

Signature of Candidate

Candidate’s Birthdate: day month (spell word) year

FOR OFFICE USE

If you initial here, you confirm that you DO NOT give permission for AFS to use such letters, images andaudio recordings of your child. In this case, your child may not be allowed to be part of AFS group photos, etc.

Updated Aug 2008

Page 10: AFS Application

Big Lagoon in El Nido, Palawan, Philippines

Sheridan Beach Resort and Spa in Puerto Princesa City, Palawan, Philippines

Elijah Daniel Batislaong Geanga Philippines Canditate Name (First/Middle/Last) Home Country

Page 11: AFS Application

Skywalk Extreme at Crown Regency Hotel & Towers in Cebu City, Philippines

Elijah Daniel Batislaong Geanga Philippines Canditate Name (First/Middle/Last) Home Country

Together with a friend in Bulalacao Falls, Palawan, Philippines

Page 12: AFS Application

Beautiful Sunset in Boracay, Philippines

Chocolate Hills in Bohol, Philippines

Elijah Daniel Batislaong Geanga Philippines Canditate Name (First/Middle/Last) Home Country

Page 13: AFS Application

I love to hold wild kind of animals like snakes, tiger, bearcat, crocodile & etc.

I like watching movies in the cinemas withfriends.

Wearing the Zorro Costume during anAFS Activity

Elijah Daniel Batislaong Geanga Philippines Canditate Name (First/Middle/Last) Home Country

Page 14: AFS Application

My classmates when I was in high school During my graduation day

My mother and father during our vacation

Elijah Daniel Batislaong Geanga Philippines Canditate Name (First/Middle/Last) Home Country

Candidate Signature Date

Page 15: AFS Application

Greetings!

I am Elijah Daniel B. Geanga, 17 years old. My mother is Elizabeth and my father is Ephraim. My mother is an elementary teacher in a public school while my father is a retired electrician and now a farmer of our own rice farm. I am currently in college pursuing Bachelor in Secondary Education Major in English. I should have a sister but she died in an early age of 1 year old and 7 months because of cardiovascular problems.

My family would describe me that I am outgoing, very sociable, talkative, helpful, and always ready to do the household chores. They told me that I really know how to interact with others, with the students, teachers, foreigners and even those professionals. According to some of my friends, I am open-minded, a very generous man, even sometimes I forget myself. They told me that I am always ready to help everyone and I could never say “no” or in an easy way of saying that I don’t know how to refuse others, even though I still have some tasks to do. If you ask me about computers or something that favored me that is connected to computers, I always try to help. They told me that I am pleasing everybody of those requests. Some of my teachers told me that I am always conscious about my looks, if I am well-groomed, handsome and look good always. They told me that I have an attractive personality, kind-hearted, humble and nice. When I asked one of my best friends about my attitude he answered: “You are a kind of man who knows how to listen and will not make any unnecessary conversations with others. You are very flexible and you really know how to deal with different situations.”

My relationship with my family is very good, when it comes to family matters I am quite serious and I always find time to have a conversation with them about my decisions, problems and stories. As what I had stated before that I don’t have any brothers or sisters because my sister died in an early age of one year old and seven months because of cardiovascular problems. There are also some types of situations that I seek an advice from my parents like if I am troubled in school specifically about my classmates. I also seek their advice about my studies, travels and what should will I do if I encounter some problems.

My relationship with my friends is excellent. It is such a great feeling that you have a lot of friends coming from different parts of the world. I usually find time to be with my friends and we usually do a lot of activities together like watching movies in the cinema, eating together, sharing stories and having fun together. I can say that I am quite different with my friends because I usually concentrate with activities like travelling, meeting more people and trying to be more serious in my life. I think I am more ambitious and I have a lot of goals in my life. I seek for success unlike most of my friends would tell me that they are contented for what they have. To sum it up, I am really seeking forward to make a difference.

My major interest are meeting a lot of people, exploring places, cooking, learning & discovering new things, technologies, and adventures, going to different beach resorts and holding different kind of animals. I usually find time for my work-out. I really love music such us country songs and reggae’s. I also like eating different kind of foods and walking around especially in the park. Sometimes, I find a convenient time to go to a bar and drink something but not too much. Usually, I am very flexible and easy going, I am very thankful for whatever activities.

Page 16: AFS Application

I have a different role in my community. In school, I usually run errands for the student as well as with the teachers if they need something. I had been a class mayor for 3 consecutive years and I had been a president of a library club. Right now, I decided not to have a part in any school government organizations because I wanted to concentrate in my studies. In community activities, I always try to get involved in any activity like tree planting, community service, coastal clean-ups, feeding program, run for fun and many more. I am always active and willing to help and to give contributions in my community.

When I was still a child I dreamed of going out of my country. As I grow older I tried to seek an open gate that will help me to let a new experience to other country. It was my first year in college when I discovered AFS. It was my first time to know meet a lot of people coming from different countries and as they tell their stories about their country and about their activities and culture the more that I am motivated to apply for an AFS Program. My personal goals for the program are to share something about my culture, tradition, society, values, and education.

I don’t have any part of my life that I found frustrating and difficult. As what I have told you earlier I am easy going and flexible. I think if you know how to face problems and how to solve and deal with it you will not find any frustrations in your life. Whether I had been successful or not I can still say that the greatest results in life are usually attained by simple means and the exercise of ordinary qualities. These may for the most part be summed in these two: commonsense and perseverance.

My greatest dream in life is to always live my life with a heart full of love, kindness, peace and humility. For now, my main target is to finish my studies as an educator. In the future, I want to have a better job so that I can support my family and so that I can pay back my parents. I want my life to be more productive where I can obtain what I wanted and have everything that I need. I also want to establish an organization that helps people in need. Doing good deeds lightens my mind and makes me happy.

Sincerely yours,

Elijah Daniel Geanga