Epinal Student Application

Student Information
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Browse Files
This will be sent to the correspondant Cancelof
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Male/Female
Mobile Number

Area CodePhone Number
Student E-mail
School Name
Grade Level
Language being studied
The La Crosse - Epinal exchange has been a over 30 year tradition in our area. The sharing of culture has been and will always be very important. The typical exchange includes an american student hosting in year 1 and then travelling the following year to stay with their students family. However, due to various circumstances, we understand that it is not always possible.

While we would prefer students who are willing to both host and travel, in that order, we are also open to other options. We have many more French applicants than American each year and would love to be able to accomodate more of them. If you are currently unable to host or travel, please still apply. Include your intentions below. If it works out with a student in Epinal, you will be included in the exchange.

If your circumstances change in the future, we will do our best to help you continue to be a part of the exchange.
I am interested in:

Hosting and travelingHosting Only preferredTraveling only preferred

Family Information

Please enter any necessary information
Guardian 1
Guardian's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Career
Languages spoken other than English
Guardian 2
Guardian 2 Name

First NameLast Name
Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If different addresses, please indicate where the correspondent will be staying
Phone Number

Area CodePhone Number
Email
example@example.com
Career
Languages spoken other than English
Are there any brothers or sisters in the household? Please include ages.
Full names with year of birth
Do you have any pets? Which?

Hosting
What gender of correspondent would you be interested in hosting?

MaleFemaleI would host a correspondent of the opposite sex if needed
Correspondent housing arrangements

They would share a roomThey would have their own room

Student Personality and Health

We use this to pair students with someone compatible, both in personality as well as with allergies (avoiding pets, etc). When we travel, it is also important that we are aware of any health concerns.
Parents: Describe in a few words the personality of your child:
Does the applicant have any health concerns or allergies?
Any dietary restrictions?
Interests

These will help us make the best possible matches among candidates.
Please list any hobbies or sports
What kind of music do you like? Do you play any instruments?
Are there any other interests we could consider when matching correspondents?
How would you describe your family's summer lifestyle? Select all that apply

ActiveRelaxedOutdoorsAthleticHome OrientedDay tripsWorking

Motivation
Explain why you wish to be a part of the exchange program and what you hope to learn from the experience. If you are a French student, feel free to write in French.

Recommendations

Include emails of your foreign language teacher and two other unrelated adults. We recommend one other teacher or counselor and another friend of the family, for example. They will receive a form to fill out for your recommendation.
Language Teacher's Email
example@example.com
Adult Email 1
Other Teacher/Counselor
Adult Email 2
Unrelated adult
Signatures
Guardian Signature

Clear
Guardian Signature

Clear
Student Signature

Clear
Should be Empty:

Student Application