THE MARINE SOCIETY AND SEA CADETS FORM SCC T14 INTERNATIONAL EXCHANGE CADET NOMINATION FORM Please ensure that you complete this form using capitals and in black ink. This form should only be completed by Cadets and those nominating cadets to take part on an International Exchange during 2015. There are opportunities available to visit Australia, Bermuda, Canada, Hong Kong, Japan, Sweden, South Korea and USA. Cadets will be allocated to any one of the exchanges and must be prepared to go where allocated. Parents/guardians must acknowledge that cadets may be required to travel through London unsupervised. Please attach passport sized photo here Please indicate on the form if you will be unable to attend particular dates due to exam periods, prior commitments etc. Personal Details *Where indicated please ensure the information that you provide is exactly what is in your passport Surname* Forename/s* Name which you prefer to be known as Rank/Rate SCC Unit Date of Birth* SCC Area Place of Birth* Male/Female Passport Number* Place of issue of passport* Passport Expiry Date* Date of Passport issue* Blood Group Nationality* Contact Details Full Home Address Post Code Home Phone Number Mobile Phone Number Email Address Name of Next of Kin Relationship to Applicant Home Address Post Code Home Phone Number Email Address Mobile Phone Number To be completed by the Cadet Why Do You think you should be selected to participate on an international exchange programme? Are there any Countries listed that interest you? Are there any Countries that you do not want to be selected for? Please list any dates you are unable to attend (e.g school exams, holidays) I understand that if selected I will need to complete a day to day diary to record my experience on the exchange. Printed name of Cadet Signature of Cadet Parent / Guardian Consent for cadets placement and all travel arrangements. By signing this form I give consent for my child to travel through London unescorted. I also acknowledge that by applying for this programme a £1000 (or £500 for Sweden) contribution will be required. NB cadets who need bursaries are to write to the exchange officer at complete a bursary form. Please contact [email protected] for more information Printed Name of Parent/ Guardian Signature of Parent/Guardian Qualifications and Hobbies (Please attach a copy of your SCC qualifications from Westminster) Medical and Dietary Information Do you have any medical conditions or allergies the MSSC should be aware of? I.e. Asthma, diabetes etc. If yes, please specify including any medication needed Do you have any special dietary requirements? I.e. Vegetarian, Halal, Diabetic, allergies If yes, please specify: Yes □ No □ To be completed by the Commanding Officer Why Do You think this Cadet deserves to be nominated? Commanding Officer Endorsement Printed Name and Rank of Commanding Officer Signature of Commanding Officer Please return completed forms directly to the International Exchange Coordinator either by post or email. Applications are to arrive no later than Monday 26th January. Applications received after this date will not be accepted. International Exchange Coordinator Nicola Martin The Marine Society and Sea Cadets 202 Lambeth Road LONDON, SE1 7JW Fax: 020 7928 8914 For further information please contact the International Exchange Coordinator, Nicola Martin at MSSCHQ on: 0207 654 7045 [email protected]