ExpatYouthScholarship.com | Sponsored by Clements International

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Name (First Last)*

Age*

Gender*

Male Female

Address:*

City:

State: (If U.S.)

Country:*

Postal Code:*

Home phone:*

E-Mail Address: *

Country of passport:(Citizenship)*

Time away from home country:(Years, Months)*

Family Information

Father's name:*

Current Employer:

Mother's name:*

Current Employer:

What other countries have you lived in? (if any)

Foreign Location 1:

Time spent:(years, months)

Foreign Location 2:

Time spent:(years, months)

School Information

School Name:*

Address:*

City:*

Country:*

Entry Information

Essay topic/title:*

Copy and paste your essay into the box below:*

Creative Media
Creative media may be submitted digitally as, JPEG, TIFF or PDF.
Use the following format to name each of your files before uploading "lastname_firstname_filename".
(If Needed) (If Needed)

I herby authorize and consent that Clements International, its legal representatives, successors or assigns, shall have the absolute right to copyright, publish, use or assign any and all creative media (essay, illustration, photograph, movie/sound recording) or any part thereof, that I have submitted on this date(s) or in which I may be included in whole or part, whether apart from in or connection with, illustrative or written printed matter, story or news item, television or radio spots, world wide web published, or for publicity, advertising or any other lawful purpose whatsoever, in conjunction with my own or a fictitious name, or in reproductions thereof in color or otherwise. I hereby waive all claims for any compensation for such use or for damages. I hereby waive any right that I may have to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith or the use to which it may be applied. I (student) and my legal guardian (parent) have reviewed the above authorization and release, prior to its execution, and that we are fully familiar with the contents thereof. By entering your name below you are agreeing to the above release

*	*
Student Signature	Legal Guardian/Parent

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2009 Scholarship

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