Sister Cities of Nashville Student Exchange Chaperone Application

Indicate which program you are applying to chaperone for.*

Caen and Paris, FranceMendoza, ArgentinaMagdeburg and Berlin, Germany

Sister Cities sponsors high school student exchanges for the purpose of exposing students to cultures and languages of different countries . Chaperones are an important factor in the students’ experience. Chaperones are asked to study the country and be prepared to help make this an educational experience for students during the exchange experience. and to work closely with the exchange coordinators in the host country in developing the program. While in the host country, chaperones are expected to accompany students on outings, be available for the students if there is a need or concern, and to participate in all activities with the students. Chaperones, working closely with SCN and city committees, are also expected to help coordinate the reciprocal visit by exchange students to Nashville.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

School*

Principal Name*

First NameLast Name

Subjects Taught*

Profession if not a Teacher

Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Activities and interests*

Foreign Language(s) spoken*

Have you traveled abroad before?*

YesNo

If yes, please describe your traveling experiences (when, where, for how long).

Have you chaperoned a group of students before?*

YesNo

If yes, please describe your chaperone experience (where, when, group size).

Have you ever been discharged, not-renewed or banned from any volunteer organization?*

YesNo

Have you ever been convicted of any misdemeanor or any felony?*

YesNo

Have you ever been convicted of any offense that involves drugs or alcohol?*

YesNo

Have you ever been presently charged with a crime that is currently pending or not yet adjudicated?*

YesNo

If you answered yes to any of the previous four questions, please explain.

Please explain why you think student exchange programs are valuable and what you would expect your students to gain of the experience.*

What do want to gain personally from being a chaperone on this student exchange?*

Thank you for completing the application to be a chaperone for Sister Citiers of Nashville. We will be in touch shortly! If you have any questions, please contact layla@scnashville.org