Student Application J-1 Program

School Information
What is your preferred grade of enrollment?*

9th Grade (Freshman)10th Grade (Sophomore)11th Grade (Junior)12th Grade (Senior)
ARISE does NOT guarantee that a student will be enrolled in the grade of his/her choice. This decision is at the sole discretion of the school.
Will you graduate from high school prior to the exchange program start date?*

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?*
Please describe your study habits.*
What will you do to make your experience at your American high school a success? Are there any extracurricular activities you would like to participate in?*

Family Description
Please provide us with information about your legal guardians (These are the adults who are legally responsible for you. They may be your natural parents or other adults).
Parent/Legal Guardian #1's Name:*

First (Given)Family Name
Relationship to You:*
(Father, mother, grandparent, etc.)
Parent/Legal Guardian #1's Cell Phone:*

Country CodeArea CodePhone Number
Parent/Legal Guardian #1's Email:*
example@example.com
Age:*
Gender:*
Employment Status:*
If other, please explain below.*
Occupation:*
(Doctor, lawyer, teacher, etc.)
Do you have a 2nd parent/legal guardian?*

YesNo
Parent/Legal Guardian #2's Name:*

First (Given) NameFamily Name
Relationship to You:*
(Father, mother, grandparent, etc.)
Parent/Legal Guardian #2's Cell Phone:*

Country CodeArea CodePhone Number
Parent/Legal Guardian #2's E-mail:*
example@example.com
Age:*
Gender:*
Employment Status:*
If other, please explain below*
Occupation:*
(Doctor, lawyer, teacher, etc.)
What is your parents'/legal guardians' marital status?*

MarriedDivorcedSeparated
Are both of your parents/legal guardians still living?*

YesNo
If not, please explain.*
With whom do you live most of the time?*
Please explain.*
Do you have any brothers or sisters?*

YesNo

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 friends or relatives, as well as where they reside in the U.S*
By typing my name below, I certify that the information included in this application is true and correct to the best of my ability.*
Student's Electronic Signature
Date

MonthDayYear
Date
PAYMENT OF THE NON-REFUNDABLE/NON-TRANSFERRABLE APPLICATION FEE:

The application fee of $200.00 must be paid prior to submitting this form and is NON-REFUNDABLE and NON-TRANSFERRABLE. Please enter the credit card holder's information by clicking on the link below:
10810 N. Tatum Boulevard, Suite 102-845 Phoenix, AZ 85028 www.arise-usa.org

Toll-Free: 1-877-6-ARISE-6 Phone: (602) 641-9699 Email: info@arise-usa.org
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Student Application