The ICAS Youth Excellence Program

Institute for Corean-American Studies, Inc.

Leadership Training Conference in Washington D C

March 30, 2010 Tuesday 6:00 AM - 10:30 PM

Let's Learn More about America
Developing Winning Strategy

Opening Young Minds and Expanding Horizons
Building Capacity, Fostering Opportunity, Investing in the Future
Enhancing Good and Productive Citizenship

Immersing in the Culture of Excellence
innovative Leadership par excellence

Meet, Visit, Greet, Brief

Heritage Foundation with senior officials
Library of Congress with senior officials
The Capitol with senior officials
The White House with senior officials
US Department of Justice with senior officials

(subject to amend, change, modification and security clearance/environment)

Delegate qualifications: student (B+ average and school's permission)
youth (college students, gradaute/post-graduate students)

Guide: ICAS Staff and Faculty
Inquiry: ICAS@icasinc.org

REGISTRATION First Come First Served;
A Security Clearance Process (SCP) will commence immediately upon commitment to participate.

RSVP by March, 2010

Student's/Participant's Name: ________________________________grade___________________
Email __________________________________ Tel __________________________________
Date of Birth ____________________________________________________________________
Place of Birth ___________________________________________________________________
Nationality __________________ Passport Number (for non-US citizen) _____________________
Social Security Number (for security clearance purpose only)________________________________
Father's/Mother's/Guardian's Name ___________________________________________________
Mailing address __________________________________________________________________
Tel ______________________ Fax ________________ Email _____________________________
Name of school __________________________________________________________________
Principal's name __________________________________________________________________
Tel: _____________________ Fax: ________________ Email _____________________________

Participating students will be invited to an orientation workshop+ which will include a lecture on
+date, venue TBA soon

How to Build Brain Power?
How to Enhance Academic Performance?

Preparing for College/University (i.e., BA, BS)
Graduate School/Professional School (i.e., PhD, JD, MBA, MD)
Preparing for Post-College/University Career Development

Qualified student participants may be invited to compete for ** ICAS Youth Excellence Fellowship Awards Contest Invitational 2010 and ICAS AP Program.

** ICAS Youth Fellowship Award
ICAS Youth Excellence Fellowship Awards Invitational 2005 Winners
Youth Excellence Award Winners

Release of Liability
Date this form executed _______________________________

Applicant's Name ________________________________ DOB _________________________
Age __________________ Grade ___________________ Signature ______________________
Parent/s, Guardian/s Name/ _________________________________________________________
Mailing Address _________________________________________________________________
Name of School you attend _________________________________________________________
Principal's Name _____________________________
Tel ________________________ Fax _________________ Email ______________________
Emergency Contact Person __________________________________________________________
Relationship _________________ Tel __________________ Email _________________________

Any Concerns (i.e., medical, et al) of which we should be aware. (Please use a separate page if needed)

Health Insurance Inforamtion: Policy Name _____________________________________________
Policy Holder _____________________________________________
Policy Number ____________________________________________

How did you hear about the ICAS Youth Excellence Program ( ICAS YEP)?


Did you participate in the ICAS YEP during the past year?


Release of Liability

In consideration of acceptance as a participant in the ICAS YEP, I hereby agree for myself, my heirs, my executors, administrators and any minor child (if applicable) to waive and release any and all rights and claims for damages I may have against the ICAS , its employees, other ICAS members, directors, staff, fellows, and their respective families, sponsors, and their representatives, successors, and assigns and will hold them harmless for any and all inuries suffered in connection with any ICAS YEP event/s or while traveling to or returning there from. Also, non of the above are responsible for the loss of personal items and any other form of aggression in connection with any ICAS YEP activities.

I verify that I am physically fit and that my physical condition has been verified by a licensed medical doctor. I also hereby consent to permit emergency treatment in the event of injury or illness.

Signature of parent(s)/guardin _______________________________

Date _______________________________

NB: A parent/guardian must fill in this form.

ICAS reserves all rights including the right to dismiss any participant and, in that case, no refunds shall be made. Any cancellation requiring a refund must be made in writing with two weeks advance notice. Otherwise, there shall be no refunds. Further details will be provided upon completion of registration.

--------------------------------------------------------------------------------------------------------- veritas vos liberabit

Sang Joo Kim
Sr Fellow & Executive Vice President
Institute for Corean-American Studies, Inc. ( ICAS)
ICAS Liberty Foundation
965 Clover Court
Blue Bell, PA 19422

E: icas@ ICAS inc.org

-------------------------------------------------------------------------------------------------------- Institute for Corean-American Studies (aka ICAS) is a non-profit, non-partisan, and private educational and research organization. It is not an agent of any government and solely supported by voluntary contributions. ICAS promotes pertinent relations and conducts appropriate activities to enhance cooperation and to pursue peace and prosperity. Further information about ICAS and some examples of the recent activities may be found on the ICAS website (http://www. ICASinc.org).

Thank you.


ICAS Liberty Foundation seeks to promote the cause of humanity, peace, prosperity and security through cultural, educational and research activities.

All Rights Reserved. April 12, 2013