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2. Student Agreement Form

   If selected, I agree to attend general orientation sessions along with additional training classes on Japanese language, customs, and culture. I understand that students selected for the Program must be positive representatives of Shelby County, and will be expected to display good citizenship and community values during the trip. 

4. Electronic Signature Agreement*

   If selected, I agree to attend general orientation sessions along with additional training classes on Japanese language, customs, and culture. I understand that students selected for the Program must be positive representative of Shelby County, and will be expected to display good citizenship and community values during the trip. 

   By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

   1. I agree.
6. Electronic Signature*
7. Date of Acknowledgement*
   Date of Acknowledgement
11. Next Step:

    Upon hitting "submit" you will be redirected to the "Parent/Guardian Permission Form" to be complete by your "Parent/Guardian." Applications will not be considered "complete" until

    1.  Completed student application submitted

    2. "Student Agreement Form" is submitted

    3. "Parent/Guardian Permission Form" is submitted

    4. $250 deposit mailed to  SCIRC RE: "Student First and Last Name" City Hall 44 W Washington Street, Shelbyville, IN 46176

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13. 1. Receive an email copy of this form.
14. Email address

    This field is not part of the form submission.

15. Submit

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