Gastonia Sister Cities Program

Application

Location:

Germany

Peru

I. Student Information:

Nick name or preferred name:

Full Address:

Address or Location

Student Cell Number:

Birth date:

Email:

II. School Information:

Name of School Attending:

If Other, enter School Attending:

Language Teacher

Grade:

Freshman (9th)

Sophomore (10th)

Junior (11th)

III. Family Information:

Mother's/Guardian's Name:

Phone: Home/Cell

Phone: Work

Email (if different from student's)

Father's/Guardian's Name:

Phone: Home/Cell

Phone: Work

Email (if different from student's)

IV. Essay Questions (Required):

1. Explain why you want to participate in the program and what you hope to get out of the experience.

2. Why would you like to visit Germany or Peru? Include what you think Germany or Peru would be like, also include why you may not want to visit.

3. Describe yourself. Include all extracurricular activities and community involvement.

V. Please attach current transcript of grades/academic records with attendance.

Upload File(s)

Click Here to Upload

VI. Teacher Recommendations:

We need at least 2 recommendations: current teacher, church leaders, coaches, scout leaders, etc. One letter must be from your language teacher.

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. Do you have any dietary restrictions?

YES

If YES, please explain:

5. 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:

6. Have you ever traveled to another country?

YES

If YES, please explain:

VIII. I have completed the application for the Sister Cities Program and understand the requirements and guidelines.

Photography Release: By my signature, I hereby give permission for my child to be photographed during events, classes, and special activities held by Sister Cities, and I give my permission for those photograph(s) to be used, without restriction as to changes or alterations, for advertising, promotion, exhibition, or any other lawful purposes. I waive any right to inspect or approve the photograph(s) that may be used now or in the future, whether that use is known or unknown to me, and I acknowledge that I understand that there will not be any compensation arising from the use of the photograph(s).

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:

FOR PERU ONLY: We have VERY limited scholarships each year. If you would like to apply for a scholarship please request an application and submit that to our offices ASAP. No scholarships will be awarded after the final amount has been stated.

Are you declining to apply for a scholarship?

Yes, I am declining.

No, I want to apply for a scholarship.

Receipt

You will be provided with a Receipt upon submission.