CISV 2017 Program Interest Survey Question Title * 1. For 2017, what CISV programs are you interested in for Child #1? Village Age 11 (4 week program) FACES of Jacksonville Rising 5th, 6th and 7th Grade (2 week local program) Interchange Age 12-13 (2 weeks in Jax, 2 weeks abroad) Interchange (age 14-15) (1 month in Summer 2017 in Jax; 1 month in Summer 2018 abroad) Youth Meeting Delegation Age 12-13 ( 8 or 15 day program) Youth Meeting Delegation Age 14-15 (8 or 15 day program) Youth Meeting Individual Age 16-18 (8 or 15 day program) Step Up (Summer Camp) age 14 (3 week program) Step Up (Summer Camp) age 15 (3 week program) Intl Village Jr. Counselor Age 16-17 (4 week program) FACES Jr. Counselor Age 16-17 (2 week program) Seminar Age 17-18 (3 week program) Youth Meeting Individual Age 19+ (8 or 15 day program) Int'l Peoples Project age 19+ (14 to 23 day program) Question Title * 2. For 2017, what CISV programs are you interested in for Child #2? Village Age 11 (4 week program) FACES of Jacksonville Rising 5th, 6th and 7th Grade (2 week program) Interchange Age 12-13 (2 weeks in Jax, 2 weeks abroad) Interchange Age 14-15 (1 month in Jax Summer 2017; 1 month abroad in Summer 2018) Youth Meeting Delegation Age 12-13 ( 8 or 15 day program) Youth Meeting Delegation Age 14-15 (8 or 15 day program) Youth Meeting Individual Age 16-18 (8 or 15 day program) Step Up (Summer Camp) age 14 (3 week program) Step Up (Summer Camp) age 15 (3 week program) Intl Village Jr. Counselor Age 16-17 (4 week program) FACES Jr. Counselor Age 16-17 (2 week program) Seminar Age 17-18 (3 week program) Youth Meeting Individual Age 19+ (8 or 15 day program) Int'l Peoples Project age 19+ (14 to 23 day program) Question Title * 3. For 2017, what CISV programs are you interested in for Child #3? Village Age 11 (4 week program) FACES of Jacksonville Rising 5th, 6th and 7th Grade (2 week program) Interchange Age 12-13 (2 weeks in Jax, 2 weeks abroad) Interchange Age 14-15 (1 month Summer 2017 in Jax; 1 month Summer 2018 abroad) Youth Meeting Delegation Age 12-13 ( 8 or 15 day program) Youth Meeting Delegation Age 14-15 (8 or 15 day program) Youth Meeting Individual Age 16-18 (8 or 15 day program) Step Up (Summer Camp) age 14 (3 week program) Step Up (Summer Camp) age 15 (3 week program) Intl Village Jr. Counselor Age 16-17 (4 week program) FACES Jr. Counselor Age 16-17 (2 week program) Seminar Age 17-18 (3 week program) Youth Meeting Individual Age 19+ (8 or 15 day program) Int'l Peoples Project age 19+ (14 to 23 day program) Question Title * 4. Are there any countries that you or your child would especially like for a CISV program? Question Title * 5. Please check any country where you would NOT send your child? Argentina Brazil Canada Central Western Europe: Austria, Switzerland, Germany, Belgium, Great Britain or the Netherlands Colombia Costa Rica China Ecuador Egypt Czech Republic Guatemala Honduras Iceland India Indonesia Israel Japan Korea (South) Mexico Jordan Northern Europe: Sweden, Denmark, Norway or Finland Phillipines Poland Southern Europe: Spain, Portugal, France or Italy Turkey Vietnam Question Title * 6. If your child will be 11 in Summer or Winter 2017, would you prefer your child attend a program hosted in the United States or Canada? Yes No Question Title * 7. What is the name, age and gender of Child #1? Name Age Gender Question Title * 8. What is the name, age and gender of Child #2? Name Age Gender Question Title * 9. What is the name, age and gender of Child #3? Name Age Gender Question Title * 10. Would you be willing for your child to miss school to attend a CISV program? Question Title * 11. Are you interested in serving as a leader for any of our 2017 programs? If so, please state which program. Question Title * 12. What is your name? Question Title * 13. What is your cell phone number? Question Title * 14. What is your email address? Done