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PRE-APPLICATION FORM

Fill this out and submit, e-mail or fax(66-2-3812777) it to us

Please fill in the blanks. Fields marked with * are Required.

NAME: *

LAST NAME: *

SEX: *
MALE   FEMALE

NATIONALITY: *

RELIGION: *

BIRTHDATE (MONTH): *

BIRTHDATE (DAY): *

BIRTHDATE (YEAR): *

BIRTH PLACE: *

STREET ADDRESS: *

CITY: *

COUNTRY: *

ZIP CODE: *

PHONE: *

FAX:

E-MAIL:

PASSPORT (ISSUE DATE & NUMBER): *

PRESENT SCHOOL/UNIVERSITY:

HIGHEST LEVEL OF EDUCATION COMPLETED: *

G.P.A. OF LAST 3 YEARS OF SCHOOL: *

FATHER'S NAME:

OCCUPATION:

MOTHER'S NAME:

OCCUPATION:

ENGLISH LANGUAGE STUDIED:

YEARS STUDIED:

OTHERS:

TOEFL SCORE (IF TAKEN):

WHEN:

TO WHAT CLUBS DO YOU BELONG?:

LIST:HOBBIES:

SPORTS:

LEISURE ACTIVITIES:

DO YOU HAVE RELATIVES OR FRIENDS RESIDING IN THE U.S.?: *

IF YES, WHAT CITY(-IES) AND STATE(S)?:

BRIEFLY DESCRIBE YOUR PERSONALITY?: *

WHICH PROGRAM(S) ARE YOU INTERESTED IN?: *
AU PAIR   HIGH SCHOOL YEAR   PRIVATE HIGH SCHOOL   CAMP COUNSELOR   UNIVERSITY
WORK/STUDY/TRAVEL   ESL HOMESTAY   INTERN   ESL

WHEN ARE YOU PLANNING TO APPLY AND PARTICIPATE?: *

BRIEFLY INDICATE YOUR MAIN REASON(S): *

WHAT TYPE OF WORK WOULD YOU LIKE TO DO IN THE FUTURE?:

WHERE/FROM WHOM DID YOU HEAR ABOUT OUR PROGRAMS?: *

DATE TODAY: