[City of Gastonia] Gastonia Sister Cities Program Student Application

Gastonia Sister Cities Exchange Trip 2026

Student Application

This information in this application will be used for all documentation should you be selected.

Please take your time to make sure all emails, phone numbers and information is correct. Legal names should be written as they appear on your documentation (birth certificate, license, passport, etc).

Write your essay on a separate document and be prepared to upload (copy and paste) when you submit.

First Choice Travel Location:

Germany

Peru

Either one

I. Student Information:

Nick name or preferred name:

Full Address:

Address or Location

Student Cell Number:

Birth date:

Email:

Citizenship Status:

U.S. Citizen

Permanent Resident

Resident Alien

I have or can obtain a passport to travel to/from the United States:

I hold a valid US Passport

US Citizen able to obtain US Passport

I hold a valid passport from another country

Hold or able to obtain a passport from my home country

Unisex Adult T-Shirt Size

My Parents/Guardians know that I am applying to this program:

Yes

How did you hear about this program?

Friend who has been (word of mouth)

Flyer

Social Media

School teacher or counselor

Other

If "friend" or "other" please include name or explain:

Please upload a recent headshot or school photo that could be used for media purposes., as well as sharing a profile with exchange host families.

Click Here to Upload

II. Academics and Extracurriculars

Name of Gaston County School attending:

If Other, please name:

2025-2026 Grade:

Freshman (9th)

Sophomore (10th)

Junior (11th)

Senior (12th)- only for 5 year programs (GEC)

Current Cumulative GPA:

In a few sentences, describe yourself.

Additional scholastic programs (Advanced Placement, International Baccalaureate):

Language Courses or abilities (school or on own, how long did you study, level of proficiency)

School clubs (Interact, Robotics, National Honor Society):

Athletics or Arts Participation:

Community Involvement (Mayor's Youth Council, Religious Involvement, Scouts):

School/Community Honors /Awards/Special Programs (Scouts, National Honor Society, Governor's School, Commissioner's School):

Employment: List any past or present work, and length of time employed.

III. Family Information:

Mother's/Guardian's Name:

Mother/Guardian Occupation:

Phone: Home/Cell

Phone: Work

Best Email:

Father's/Guardian's Name:

Father/Guardian Occupation:

Phone: Home/Cell

Phone: Work

Best Email:

Additional Emergency Contact Name:

Emergency Contact Phone Number

Emergency Contact Relationship

Sibling (over age 18)

Grandparent

Aunt/Uncle

Friend of Family

IV. Student Travel Experience

What is the longest time you have been away from your family?

One night

One weekend or long weekend

A week or more

I haven't been away from my family overnight

Have you traveled by plane before?

Have you ever hosted an exchange student or business person before?

Describe any trips you have experienced without your family, Stateside or otherwise. Please include location, purpose, who did you travel with, length of time etc. If none, write none.

Please describe trips you have experienced outside of the United States (if any). Include the location, year, and purpose (vacation, family visit, study abroad, etc.) If none, write none.

V. Essay

The essay needs to address:

What personal goals do you have for this experience?
What do you hope to experience about the host country’s culture, people, and way of life?
In what ways do you think this experience will impact your future — in school, your community, or your career?

Your essay should be 12 pt font Arial or other sans serif font, double spaced, 1" margins.

400-500 words.

It should be in your own words, do not use AI.

Upload File(s)

Click Here to Upload

VI. Teacher Recommendations: Use PDF form or link on website

You will need two letters of recommendation that can be located on the website as PDF or via online form submission.

One must be from a teacher, and one must be from from another adult (mentor, coach, community member, etc).

If your reference has given you copies, you may scan and upload them to submit with this application.

You can also have your references use the online form (on the website that you accessed for this form) to submit directly, or they can print and mail their forms in (mailing address on the PDF).

Your application is not complete until both letters of reference are recieved online or otherwise. All parts of the application are due by October 15, 2025.

Upload File(s)

Click Here to Upload

VII. Please answer these questions in reference to housing.

1. How many people live in your household?

2. Will your family be willing to host an exchange student for approximately two (2) weeks?

YES

3. What kind of accommodations will you provide for your host student? (share a room/have their own room, etc.)

4. Pets you have in the home:

Dog

Cat or Rabbit

Bird

Reptile

Fish

Small Mammal (hamster, rat, gerbil, guinea pig etc)

None

Other

5. Do you have any dietary restrictions?

YES

If YES, please explain:

6. Do you have any physical restrictions, impairments, or allergies that will limit placement options or participation in everyday family and/or school activities?

YES

If YES, please explain:

VIII. Student Signature

We have VERY limited scholarships each year. If you would like to apply for a scholarship, please check the box below and an additional form will be sent to your email.

Are you declining to apply for a scholarship?

Yes, I am declining.

No, I want to apply for a scholarship.

By signing below I attest that I have completed the application for the Sister Cities Program and understand the requirements and guidelines. I also acknowldege that the answers in this application are my own work, and I am truthfully replying to all questions.

I understand that my photo and likeness may be used and that there may be videos for purposes of documenting or advertising for the trip by Gastonia Sister Cities, the Shelby Star (Gaston Gazette), Gaston County School publications or other vetted entities. I acknowledge that there will be a media project that I will participate in and my work may be used to support the program in visual, audio, or other media methods and that I will be credited for such work but not compensated through the program.

I, the undersigned student, affirm that as a participant:

I will represent my home community with respect and responsibility.
I will follow the rules and expectations outlined by the program organizers and chaperones.
I will maintain regular communication with my group leaders.
I will conduct myself in a manner that reflects positively on myself, my family, and my school.
If selected from the applicant pool I will be available for the group interview on Saturday November 8, 12 pm in downtown Gastonia.

Student Signature:

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Today's Date:

Receipt

You will be provided with a Receipt upon submission.