The ICAS Youth Excellence Program

Institute for Corean-American Studies, Inc.

Leadership Training Conference in Washington D C

April 3, 2012 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, Greet & Visit, Brief & Confer, Lead

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
US Department of State with senior officials

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

Delegate qualifications: student (B+ average and permission of parents/school)
youth (middle/high school, college students, graduate/post-graduate students)
Guide: ICAS faculty and staff

REGISTRATION First Come First Served;

A Security Clearance Process (SCP) will commence immediately upon commitment to participate.

RSVP by February 20 , 2012

Student's/Participant's Name (L, F, MI)_____________________________________
Grade_____________________ Gender (F, M) _______________________________
Email _______________________________ Tel ______________________________
Date of Birth __________________________________________________________
Place of Birth (City, State)_______________________________________________
Nationality ____________________________________________________________
Passport Number (for non-US citizen)______________________________________
Social Security Number (for security clearance purpose only)____________________
Father's/Mother's/Guardian's Name ________________________________________
Mailing address ________________________________________________________
Name of school attending ________________________________________________
Principal's name _______________________________________________________
Tel ___________________ Fax _____________ Email ________________________

Qualified student participants will be invited to an orientation program and a lecture/workshop series on
How to Build Brain Power?
How to Enhance Academic Performance?

Preparing for College/University (i.e., BA, BS)
Are You College-Ready? How Do You Know?
How to Finance Education
Graduate School/Professional School (i.e., MA, MS, PhD, JD, MBA, MD)
Preparing for Post-College/University Career Development
Are You Career-Ready?

Qualified student participants may be invited to compete for **ICAS Youth Excellence Fellowship Awards Contest Invitational 2012 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 (ICASYEP)? _______________________________________________________________________________
Did you participate in the ICASYEP during the past year? ____________

Release of Liability

In consideration of acceptance as a participant in the ICASYEP, 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 ICASYEP 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 ICASYEP 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)/guardian _______________________________

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

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 ( 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. January 31, 2012

This page last modified January 14,2012 jdb