BIG Student Application

Student Application Form

Fill out the form carefully for registration
Profile

Contact Details
Student Name

First NameMiddle NameLast Name
Nickname / American Name
Birthdate

MonthDayYear
Age
Gender
City of Birth
Country of Birth
Current Home Address

Street Address

Postal Zone

CityState / Province

Country
Student E-mail
example@example.com
Home Phone
Mobile Phone

Profile

Citizenship & Passport
Holds US Passport
Passport Number
Expiration Date
Country Issuing Passport
Passport expiry Date
Upload PASSPORT picture

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Profile

Languages
How many years have you studied English in school?
How many years have you studied English in private lessons?
Where do you practice speaking English?

Profile

Religion
Religious Affiliation
How often do you attend religious services?
Do you agree to attend church 2x a month with your new host family to improve English?

Profile

Preferences
Do you have any dietary preferences?
Do you smoke or vape?
Americans love their pets! To be considered for the program you must be capable and ready to live in a home with a cat or dog. If you are allergic you must be able to treat your allergies with appropriate medication.

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Family

Family and Household
Parents Marital Status
Who is legally responsible for you?
How many siblings do you have?
List of chores for which you are responsible at home?
How many pets do you have? List them?
Residence Community Type?
Upload Picture of your family

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Father or Legal Guardian
Father's Name

First NameMiddle Name
Birthdate

MonthDayYear
Home Phone
Mobile Phone
Work Phone
E-mail
example@example.com
Current Home Address

Street Address

Postal Zone

CityState / Province

Country
Occupation
Please Upload a picture of your Dad

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Mother or Legal Guardian
Mother's Name

First NameMiddle Name
Birthdate

MonthDayYear
Home Phone
Mobile Phone
Work Phone
E-mail
example@example.com
Occupation
Current Home Address

Street Address

Postal Zone

CityState / Province

Country
Please Upload a picture of your Mom

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Brothers and Sisters
Name

First NameLast Name
Gender
Age
Live at home
Name

First NameLast Name
Gender
Age
Live at home

Activities/Interests

Organized activities ( Teams, Clubs, Band, Orchestra, Etc…)
Do you participate in any organized activities?
Activity Type
Describe your position/instrument played and how often you train/participate
Describe any awards or any recognition received

Activities/Interests

Activities /Interests Wanting to pursue while abroad
List activities you want to explore in the US
Provide a brief reason why you are interested in these activities

Motivation

Short Narrative StudentLetter
Please describe your personality and nature. List three adjectives that your friends might use for you.
Write a letter in your own words to your prospective Host Family that will tell them about you and your expectations.

Motivation

Parent Letter
Write a letter to the host family who will share their home with your son or daughter. Describe their personality and be honest about strengths and weaknesses.

Education

High School
Current School
Type of school
Dates Attended
Present Grade
School Address

Street Address

Postal Zone

CityState / Province

Country
Principal / Counselor
Phone
Email
example@example.com
Position of student in class
Number of students in class
Favorite subjects
Least favorite subjects
Subject which achieves best grades
Subject which achieves worst grades
Current GPA
Has the student studied abroad previous to this program?
If yes, in what country?
What Type of VISA?
How long was the program?
What Year?
Do you want to graduate from Capistrano Valley Christian School?

Education

Translated Transcripts
Upload Transcripts

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Medical

History and Physical Exam
Upload Immunization Records

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Program Options

Double Placement
Do you accept double placement? Students will have their own room but will share a bathroom.

Name

First NameLast Name
Signature

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