High/Middle School Form

Name & Last Name *

Date of Birth *

Sex: *MaleFemaleOther

Email Address *

Phone *

Emergency Phone & Name *

Street Address *

Apartment, suite, etc *

City *

State/Province *

ZIP / Postal Code *

Country *

Passport# (If you have it) & Nationality *

Interests/Hobbies * *

Studies

Are you traveling alone or with a group?AloneGroup

Name of chaperone

StudiesHigh SchoolMiddle School

Do you wish to receive college credits?Yes ($15 for handling paper work when applying for college credits)No

If Yes, answer How many credits do you wish to obtain? and name of the University.

What kind of credits are you applying for?College CreditsOthers

Please specify

Language Level

Languages (find your Level Written/Verbal) Spanish Level)

Native Language

Other Language

Have you studied Spanish?YesNo

If yes, answer where and how long?

Home-Stay Information

Family Special dietary needsVegetarianVeganNoOther

If checked other

I would rather live with a familyWith ChildrenWithout ChildrenPetsNo Pets

Health

Allergies

Medical problems

Comments and suggestions would be appreciated

I understand that in addition to the $100 deposit, I am required to pay half of the cost of the trip prior to departure and the remainder upon arrival. *I've read terms and conditions

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