Application YVYE6446

Ref code: YVYE6446 | 2024 | FLEX Consent American Councils Informed Consent
Consent Forms
Country of participation
Georgia
Where do you currently live?
Georgia
What is your date of birth?
Jan 06, 2009
Please note that, for the purposes of this Informed Consent form, the words “you” and “your” refer to both you and your parents/
legal guardians.
American Councils for International Education: ACTR/ACCELS, Inc., (“American Councils”, “we”, “us”, or “our”) based at
1828 L Street NW, Suite 1200, Washington, D.C. 20036-5136, United States of America, would like to inform you about the Future
Leaders Exchange (“FLEX”) program. To participate in FLEX, American Councils requires certain data about you. Your written
consent is required to continue with your application.
What Is FLEX?
FLEX offers high school students the chance to participate in an academic year exchange program in the United States of America
followed by FLEX alumni programming in their home countries. FLEX finalists attend American high schools, live with volunteer host
families, and take part in American community life. Upon return to their home country, FLEX alumni join an international network with
life-long benefits. American Councils manages FLEX on behalf of the Bureau of Educational and Cultural Affairs at the U.S.
Department of State.
What Data Will Be Collected, Used, and Stored?

For this program, your personal data will be collected, used, and stored. Different data is collected at the applicant, semi-finalist,
finalist, and alumni stages.
At the applicant stage, you may be asked to share:
▪ Demographic data, such as name, email address, telephone, address, and birth date
▪ Educational data, such as school enrollment details
▪ Photographs
▪ Other data of your choice, such as disclosure of disability
At the semi-finalist stage, you may be asked to share:

▪ Demographic data, such as citizenship and family composition
▪ Educational data, such as transcripts and teacher recommendations
▪ Photographs
▪ Mental and physical health data, such as height, weight, health history, and vaccination records
▪ Other data of your choice, such as disclosure of disability
At the finalist stage, you may be asked to share:

▪ Educational data, such as updated grade transcripts
▪ Mental and physical health data, such as updates on changes in health conditions
▪ Other data of your choice, such as on-program success stories
At the alumni stage, you may be asked to share:

▪ Demographic data, such as place of residence
▪ Educational data, such as university enrollment
▪ Occupational data, such as employment information
▪ Other data of your choice, such as awards and accomplishments
Why Is this Data Required?

Your personal data is required for the following purposes:
At the applicant stage:
▪ Initiating participation in the application process
At the semi-finalist stage:
Page 1 of 3
▪ Continuing participation in the selection process

▪ Conducting the health clearance process
At the finalist stage:

▪ Securing health insurance for the finalist
▪ Placing the finalist in the host family and school
▪ Providing on-program support to the finalist
▪ Offering additional on-program opportunities to the finalist
At the alumni stage:

▪ Engaging the alumni in alumni programming
Why Might Third Parties Have Access to My Data?

Some examples of why we may provide your personal data to third parties are:
▪ Sending you program preparation materials
▪ Arranging a home, work, and educational placements for you while on program
▪ Arranging transportation, such as airline or train, to and from your program location
▪ Arranging your participation in conferences, seminars, and other similar activities
▪ Evaluating any health and medical information that you provide to us
▪ Providing support to you while you are on program
▪ Contacting you about post-program alumni activities
▪ Generating aggregated and anonymized statistical reports that may be shared with program funders
Additional Information
For additional information about how and why we collect, use, and store your personal data, please visit our About Your Data page.
Your Consent Decision

Consent for the Collection, Use, and Storage of Personal Data
Applicant
I consent to the collection, use, and storage of my personal data in the way and for the purposes described in this Informed
Consent. Indicate your decision:
Yes, I consent No, I do not consent
Date of Consent
Aug 07, 2023
Applicant's Signature
Lika Jinashvili
Parent/Legal Guardian
I consent to the collection, use, and storage of my and my child's/ward's personal data in the way and for the purposes
described in this Informed Consent. Indicate your decision:
Date of Consent
Aug 07, 2023
Parent's/Legal Guardian's Signature
Natia Xatiashvili
Consent for the Transfer of Personal Data Outside Your Country or the European Economic Area (the “EEA” consists of
all EU Member States, plus Iceland, Liechtenstein, and Norway)
Applicant
▪ I consent that my personal data be transferred to the United States of America (“USA”) and, on a limited basis, to
other countries outside of my country of residence or the EEA.
▪ I understand that the standard protections afforded to those in my country or the EEA may not fully apply to data
that I voluntarily consent to be transferred to the USA or other countries outside of my country or the EEA.
Indicate your decision:

Date of Consent
Aug 07, 2023
Page 2 of 3
Applicant's Signature
Lika Jinashvili
Parent/Legal Guardian
▪ I consent that my and my child's/ward's personal data be transferred to the United States of America (“USA”) and, on
a limited basis, to other countries outside of my country of residence or the EEA.
▪ I understand that the standard protections afforded to those in my country or the EEA may not fully apply to data
that I voluntarily consent to be transferred to the USA or other countries outside of my country or the EEA.
Indicate your decision:

Date of Consent
Aug 07, 2023
Parent's/Legal Guardian's Signature
Natia Xatiashvili
Page 3 of 3

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Ref code: YVYE6446 | 2024 | FLEX Consent American Councils Informed Consent

What Data Will Be Collected, Used, and Stored?

At the semi-finalist stage, you may be asked to share:

At the finalist stage, you may be asked to share:

At the alumni stage, you may be asked to share:

Why Is this Data Required?

At the semi-finalist stage:

▪ Continuing participation in the selection process

At the finalist stage:

At the alumni stage:

Why Might Third Parties Have Access to My Data?

Your Consent Decision

Indicate your decision:

Indicate your decision:

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