KAP Adult Application

KAP Adult Application

Personal Information
Name *

First Name Last Name
Gender *
Birth Date *

Month Day Year
Date

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number
Email *
example@example.com
Name of School *
Grade *

Family Member's Information
Spouse/Partner Name

First Name Last Name
Phone Number

Area Code Phone Number
Email
example@example.com
Birth Date

Month Day Year
Date
Emergency Contact Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com
Birth Date *

Month Day Year
Date
Relation to you *
Names & ages of children

Personality Information

Check the number that corresponds to the degree to which you exhibit that trait *

1=rarely/lightly

2=sometimes/moderately

3=often/very much

extroverted

patient

fit/healthy

stubborn

easy-going

calm

group-oriented

open-minded

serious

adaptable

individualistic

follower

artistic/creative

humorous

self-reliant

adventurous

curious

musical

shy

confident

introverted

emotional

talkative

responsible

energetic

organized

leader

prefer to be alone

Interests and Leisure Activities
What are your hobbies and interests? *

Please indicate how often you do an activity by marking the appropriate box. *

Often

Sometimes

Never

Reading

Sports

Movies

Theater

Music

Television

Arts/Crafts/Hobbies

Shopping

Other

For each category above explain things you like within the category. Please explain what your "other" category includes. (ex. favorite book, tv show, musical, store...) *

Foreign Language and Travel Experience
What languages have you studied? *
What languages do you speak? *
Have you ever been a guest of an international host family? If so, when, where, and for how long? *
What is the longest period of time you have been away from your home without your family? When? What were you doing? *
Have you taken any trips to and/or lived in another country? Please list the country/counties and when and why you were there. *
Have you hosted persons from other countries? If so, describe the situation. *

Expectations
Please describe briefly (in a paragraph) what you hope to gain by participating in this exchange program. *
Is there anything else you think we should know?
Are you willing to be a chaperone? *
Must be at least 25 years old
I have read and understand that KAP must do their due-diligence; background checks will be done on applicants *

Yes No

Signatures
Applicant Signature *

Clear
Date Signed *
Application fee - $50. Fee can be submitted via check. Address provided upon submission of application.
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