SHORT-TERM INTERNATIONAL VISITING STUDENT
APPLICATION FOR HIGH SCHOOL (GRADES 6 TO 12)
APPLICATION INFORMATION
Applying for:
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Visit Start Date
Visit End Date
Student's Name
First Name
Middle Name
Last Name
Student's Name (if format different than in the US)
Nickname (if any)
Host Address (in the U.S.)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
Male
Female
Student's Mother's Name
First Name
Last Name
Cell Phone Number
-
Area Code
Phone Number
Email
example@example.com
Student's Father's Name
Cell Phone Number
-
Area Code
Phone Number
Email
example@example.com
If student is not living with parents in the U.S., name of Legal Guardian
First Name
Last Name
Cell Phone Number
-
Area Code
Phone Number
Email
example@example.com
Student's Address in Country of Residence
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Marital Status of Parents
Together
Separated
Divorced
Widowed
Unmarried
Father remarried
Father deceased
Mother remarried
Mother deceased
Custody
Father
Mother
Both Parents
Other
Tuition to be paid by:
Father
Mother
Other
Other schools you are currently applying to:
Previous Schools: please list applicant's previous schools, starting with the current school (name of the school, number of years attended, grades attended, city, country, and address)
Were you able to visit our school? If so, what was the date of the tour?
Please explain why you are interested in visiting a Waldorf School, especially if your student does not attend a Waldorf School. Are you acquainted with anyone in the school?
Please describe any special circumstances that have affected or may have affected your child's school experience.
Please describe your child's interests, musical instruments played, special talents, or hobbies.
Has your child received, or is he/she receiving, special tutoring, counseling or therapy? Has your child received an educational diagnosis?
Yes
No
If yes, please include the nature and dates of service and attach a copy of the evaluation.
You can upload a copy of the evaluation here if it applies.
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Please identify any health situations the school should know about, such as diagnosis, allergies, therapies (physical or psychological), medications. Please attach any assessments and medical diagnosis.
You can attach any assessment here if it applies.
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What role does media (TV, movies, mp3 players, video games, computers, etc.) play in your family life?
Home and Family Rhythms
Do you or your teen follow any special diet?
Does your teen have regular chores? (describe)
Does your teen clean his/her room?
How do you discipline your teen? (give examples)
How would you describe your teen's temperament?
What are the typical weekend family activities?
What language(s) is/are spoken in the home?
What language(s) does the teen speak?
Play
Does your teen have siblings?
What are their ages?
Describe their relationship:
What kind of activity does he/she enjoy most?
Is there anything that you feel is important to your teen's biography that has not been covered above?
Parent Signatures
By signing, I ackowledge that the above information is true and accurate.
Parent Name (Print)
Parent Name (Print)
Date
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