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BRAUNSCHWEIG YOUTH EXCHANGE - STUDENT APPLICATION
In order to facilitate the selection of your partner student for theforthcoming exchange, it would be appreciated if you answer thefollowing questions.
STUDENT INFORMATION
Student School Photo
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Name
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date
Age
*
Birthplace
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Name of your School
*
Current Grade Level
*
PARENT #1 INFORMATION
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Occupation
Relation to Student
*
PARENT #2 INFORMATION
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Occupation
Relation to Student
SIBLING/OTHER HOUSEHOLD MEMBERS
Sibling/Household Member's Name
Age
Relation
Sibling/Household Member's Name
Age
Relation
Sibling/Household Member's Name
Age
Relation
Sibling/Household Member's Name
Age
Relation
HOSTING A STUDENT
Are you willing to host a German student for about 3 weeks?
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Yes
No
Are you able to host more than onestudent from Braunschweig?
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Yes
No
If you are able to host more than one student from Braunschweig, how many more students can you host?
*
We prefer to host
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Boy
Girl
Either
Do you have an individual bed for the student to sleep in?
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Yes
No
STAYING WITH A HOST FAMILY
Do you prefer to be hosted by a
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Boy
Girl
Either
Is it okay for you to share a bedroom with you host brother or sister?
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Yes
No
If you responded yes to the last question, the hosting student must be a
*
Boy
Girl
SUBSTANCE USE
Do you drink alcoholic beverages habitually?
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Yes
No
Do you smoke or vape?
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Yes
No
If you answered yes to either of the 2 above questions, would you be willing to stop if your host family wants you to do so?
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Yes
No
Not Applicable
Do you object to others smoking/vaping around you?
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Yes
No
TELL US MORE ABOUT YOURSELF
Hobbies/What do you like to do with your free time?
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What is your favorite school subject(s) and why?
*
Do you participate in any extracurricular sports, clubs, or activities? If so, what?
*
Do you have a job? If so, where do you work and what do you do?
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Do you have certain chores or responsibilities at home? If so, what are they?
*
Do you have any allergies to dogs/cats, other animals or to any substance(s)? If so, please describe.
*
Have you studied any foreign languages? If so, what language(s) have you studied, and have you had the opportunity to use the language outside of school? Explain.
*
Do you have any pets? If yes, how many and what type of animal(s) are they?
*
Are you religious? If yes, which faith do you practice and do you attend services regularly?
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Have you taken any trips to foreign countries in recent years? If yes, which countries have you visited?
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Do you follow a special diet? If yes, please describe.
*
Do you have any medical conditions your host family or chaperones needs to be aware of? Please describe.
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Examples: seizures, asthmas, panic attacks, anxiety, depression, blindness, deafness, autism, etc.
CONVERSATION TOPICS
Which of the following topics would you feel confident/comfortable talking about with your host family?
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Religion
World History
The Economy
American Culture
U.S. History
Government
Current Events
POSSIBLE FIELD TRIPS
During your stay in Braunschweig, field trips are planned. Which of the following activities do you prefer?
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Visiting historical sites
Sightseeing in neighboring towns
Getting to know rural and urban life
Visiting public institutions
Getting to know different types of schools
Meeting/Talking to people
Shopping Trips
Visiting museums
Hiking
Bicycling
Doing other sports
Attending sporting events
Visiting businesses/factories
BACKGROUND CHECK
Would you agree to a criminal background check?
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Yes
No
Would your parent(s)/legal guardian(s) agree to a criminal background check?
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Yes
No
RECOMMENDATIONS
Please provide the names of two non-family members who could be contacted for recommendations. (Be sure to ask these people for permission for me to contact them.)
First Name
*
Last Name
*
Email
*
Area Code
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Phone Number
*
First Name
*
Last Name
*
Email
*
Area Code
*
Phone Number
*
LETTER TO YOUR HOST FAMILY
Please introduce yourself and/or your family in a letter to you partner and their family!
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PHOTOS FOR YOUR HOST FAMILY
Please add photo(s) of you and your family or any other photo you would like to share with your host partner and their family.
Should be Empty: