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Application for Mito, Japan Student Exchange Program Summer

  1. Background

    The student exchange between Anaheim and Mito, Japan began in 1984. Since then, a group of Anaheim high school students has traveled to Mito to experience the city’s history, culture, and people each year. Many students have found this to be a life changing experience:

    “This trip was amazing. I'm glad that I was able to participate in this program, which very few get to say they’ve done. Thank you to everybody who worked behind the scenes to make this possible from the chaperones, to the people at the Mito International Center, to the host families, and more. I love the host family that I was with. Nothing bad comes to mind when I think of this trip. Mito is such a beautiful place with beautiful land, scenery, and people.”

    - Steven Trinh, 2016 Mito Student Ambassador

    About the Exchange

    Up to six high school students from the City of Anaheim will be selected by the Anaheim Sister City Commission to visit Mito, Japan for two weeks from late June through mid-July in 2020. These students will travel with an Anaheim chaperone and will stay with host families in Mito. The City of Mito plans the itinerary for the trip with a schedule that includes visits to schools, meeting the Mayor of Mito and participating in numerous cultural events. Please note, that speaking Japanese is not a requirement of the Anaheim students.

    Visit the Anaheim Sister City Commission website for more information, videos, and photographs from past exchanges at www.anaheim.net/sistercity.

    Application Requirements:

    • Applications are due by 5:00 pm on Monday, December 30, 2019.
    • Students must reside in the City of Anaheim and be in grades 9-11 for the 2019-2020 academic year.
    • Must be a U.S. citizen and have a valid passport or be able to obtain a valid passport by Tuesday, March 31, 2020.
    • Must be available to attend the group meeting on Tuesday, January 14, 2020 from 6:00 pm – 7:00 pm and interviews on the evening of Tuesday, January 21, 2020 individual time TBD

    If selected to be an Ambassador, students must:

    • Contribute $1,000 to subsidize travel and travel related expenses by Thursday, February 27, 2020. Note that the Commission may be able to provide assistance with the travel fee if thestudent is unable to contribute the entire amount and/or provide fundraising opportunities forthe student to participate in.
    • Assist in the creation of a memory book following the trip that will be distributed to theAnaheim City Council, Anaheim Sister City Commission, and Mito International Association.
    • Attend all student orientations with a parent or legal guardian in May and June 2020 inpreparation for the trip.
    • Volunteer during the Inbound Student Exchange of Mito Students coming to Anaheim in lateJuly or early August 2020 and are strongly encouraged to serve as a host family for studentsvisiting from Mito, Japan.

    Application Instructions 

    • Complete the following application with the necessary signatures.
    • Obtain one letter of recommendation from a school administrator (principal, counselor, teacher, club advisor, or coach)
    • Include at least one color photo of yourself
    • Application, essay, letters of recommendation, and the photo in ONE PDF file are due on Monday, December 30, 2019. Only completed applications will be considered.
    • Please submit your completed and scanned application PDF file only to sistercity@anaheim.net by 5:00 pm on Monday December 30, 2019. Late or incomplete applications will not be accepted.
  2. Please type or print the following information. If you are selected as a Mito Student Ambassador, this information will be used to match you with an appropriate host family in Mito, Japan. All information must be completely filled out. Incomplete applications will not be given consideration.

  3. Personal Information
  4. Sex
  5. Do you have a passport that is valid for 2020?
  6. If no: Will you be able to obtain one by March 2020?
  7. Do you speak any foreign languages?
  8. Current Grade Level
  9. Do you currently work?
  10. Do you play a musical instrument?
  11. Family and Health Information

    Please list the names of each of your family members, their relationship to you, and their ages. If selected, this information will better assist us in identifying a host family for you.

  12. Do you currently take any medications?
  13. Do you have any medical problems, including allergies that could interfere with participation in this program?
  14. Are you allergic or have any fear of dogs and/or cats?
  15. Miscellaneous Information
  16. Have you ever visited a foreign country before?
  17. Supplemental
    • Obtain one letter of recommendation from a school administrator (principal, counselor, teacher, club advisor, or coach)
    • Include at least one color photo of yourself
  18. Disclaimer and Signature

    In submitting this application, we certify that the information provided is complete and accurate to the best of our knowledge. We also understand the obligations outlined on this application packet and will comply with the best of our ability.

  19. If you have any questions about the application or the Exchange Program, please contact sistercity@anaheim.net

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  21. This field is not part of the form submission.