Student Information Form

First Name *

Last Name *

Nickname (optional)

Gender

Your Religion

Address in Romanian: street, number, city, county, postal code (6digit). *

Email Address *

Cell Phone *

Date of Birth *

Will you be 18 years old by the time you travel to the USA? *NoYes

School grade during travel:

Please select your academic interest level so that we can better align your University and High School class visits.

Extracurricular activities (in school or outside of school)0 / 150

Your native language *

Other language(s) that you speakEnglishGermanSpanishItalianFrench

Your English level

Tell us about yourself *0 / 200

Sports you enjoy playing or watching *0 / 200

Please describe yourself with three adjectives *0 / 150

Do you have any pets at home?

What kinds of pets do you have?

Do you have any dietary restrictions? *

Do you have any allergies? If yes, please list/describe.

Please list/describe.

X-Do you have any medical conditions we need to know about? If yes, please describe

Please describe

Parents’ Information

Mother's First Name *

Mother's Last Name *

Mother's Occupation/Background *

Mother's Email *

Mother's Cell Phone *

Father's First Name *

Father's Last Name *

Father's Occupation/Background *

Father's Email *

Father's Cell Phone *

Do you have any siblings (brothers/sisters)? *YesNo

Please list their gender and age

Student’s Personal Letter to the Host Family (max. 500 characters) *0 / 500

Please upload a professional photo of yourself. *

No file chosen

Please upload a family photo. *

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