| Program applying for: |
| Trimester Semester Academic Year (Year ) |
| Fall (Year ) Winter (Year ) Spring (Year ) |
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| Location: |
| Aix-en-Provence Montpellier Nice Paris Tours |
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| Housing preference: |
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| About you (the student) |
| Last Name |
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| First Name |
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| Street address |
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| City |
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| State |
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| Zip |
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| Phone |
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| E-mail |
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| Date of birth |
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| Place of birth |
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| Age |
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| Nationality |
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| Social Security # |
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| About the parents |
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| Last Name |
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| First Names |
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| Street address |
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| City |
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| State |
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| Zip |
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| Home Phone |
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| Fax |
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| Mother's Work Phone |
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| Father's Work Phone |
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| Name of Brother(s) |
Age |
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Name of Sister(s) |
Age |
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| Person to contact in case of emergency, if we cannot contact your parents: |
| Name |
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Relationship |
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| Home phone |
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Work phone |
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| Personal data |
| Do you smoke? |
Yes No |
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Can you adjust to a home where others smoke? |
Yes No |
| Do you like pets? |
Yes No |
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Can you adjust to a home with pets? |
Yes No |
| Do you like children? |
Yes No |
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Can you adjust to a home with small children? |
Yes No |
| Do you attend religious services on a regular basis? |
Yes No |
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Religion: |
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| Please list any allergies or dietary restrictions you have: |
| Have you ever lived outside your own country before? |
| Yes No If yes, where and when? |
| Describe any part-time job or work experience you may have had and the related time period: |
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| List your personal interests and hobbies in order of importance (ie.: sports, music, crafts, theater, etc.) |
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| School data |
| Name of school currently enrolled in: |
| What is your current status? (ie: Sophomore, Junior, Senior) |
| What is your major? Minor? Graduation date |
| How many years have you studied French at the University level? |
| High School? |
| What is your current level in French? |
| Beginner Elementary Intermediate Advanced |
| What other languages have you studied? |
| Language 1 Years studied Proficiency level |
| Language 2 Years studied Proficiency level |
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| Do you need college credit for attending our program? |
| Yes No If yes, how many? |
| How did you find out about our programs? |
| Student Essay |
Please answer the following questions in your own words
1. Briefly describe your family relationship.
2. What do you expect to learn from studying abroad?
3. How does this program fit in with your career goals?
4. What will you do after you return from this program? |
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| I agree that the above information I have provided is true to the best of my knowledge. |
I am sending an application check for $50 made payable to:
French-American Exchange
3213 Duke Street #620
Alexandria, VA 22314 |
| Please charge the $50 application fee to my: |
| Card holder name |
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Credit card number: |
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| Expiration date: |
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Please remember to send us 4 paper photos by snail mail or one digital photo by e-mail. |
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