Student Application

Please provide your complete name as it appears on your passport.
First (Given) Name:*
Middle Name (if applicable):
Family Name:*
Program Year*
Program Length
Student's E-mail Address: (THIS CAN NOT BE YOUR PARENTS EMAIL ADDRESS)*
example@example.com
What is the name of your Home Country Representative? *
The Home Country Representative is the person or company in your country who has interviewed you.
Please type your Home Country Representative’s e-mail address below. This information is very important and MUST be correct. If you do not know the e-mail address, please contact your Home Country Representative for the correct information.*

Confirmation EmailPlease type e-mail address again to confirm.
Gender:*
Date of Birth (MONTH - DAY - YEAR*

MonthDayYear
Date
Age upon Arrival in U.S.*
City of Birth:*
Country of Birth:*
Street Address:*
Street Address, Line 2 (if applicable)
City:*
State or Province (if applicable):
Postal Code (if applicable):
Country:*
Do you have a Whats App account?*

YesNo
What is your Whats App Number*
Phone Number:*

Country CodeArea CodePhone Number
Type of Phone:*

Will you graduate from high school prior to the exchange program start date?*

YesNo
Will you need to have your school transcripts validated upon completion of the program?*

YesNo
How long have you been studying English?*
Are you currently enrolled in an English class?*

YesNo
How often do you participate in this class?*
Whose Idea was it for you to apply for participation in the cultural exchange program? *
Do you have any relatives or friends residing in the United States?*

YesNo
Please describe your relationship to these relatives or friends, as well as where they reside in the U.S.*

Cultural Exchange Questionnaire

(This questionnaire must be completed by the student in his/her own English without assistance.)
Give a brief description of your native city in relation to its historical background, main sources of income, population, most famous tourist attractions, as well as the region where it is located.*
Choose some interesting information about your native culture that you would like to share with your host family and American friends.*
Based on your knowledge of the United States and your native country, point out some major cultural similarities and differences between them.*
A true exchange program allows the American host family to learn as much about your country as you would like to learn about theirs. How are you planning to share your native culture with the American people (i.e., preparing typical foods, presenting videos or photos, etc.)?*
What sort of cultural conflict do you believe an international exchange student could experience?*
How do you think the student should cope with it?*
What benefits do you believe an international exchange student could gain by participating in this experience?*
What cultural benefits do you believe an American host family could gain by hosting an international exchange student?*
What do you think is your most important responsibility as an international exchange student?*
In your opinion, what is the key to a successful cultural exchange?*

By typing my name below, I certify that the information included in this application is true and correct to the best of my ability.*

First (Given) NameMiddle Name Family Name
Date*

MonthDayYear
Date
Should be Empty: