Student Application Step 1 of 3 33% Student InformationName as it appears (or will appear) on passport First Middle Last Preferred First Name* First Gender* Male Female Birth Date* Date Format: MM slash DD slash YYYY Age*Student Cell PhoneStudent Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country High School*Current Grade*10th11th12thLevel In Spanish*Spanish Teachers Name*Spanish Teachers Email* How did you hear about Partners? Mark all that apply* Classroom Presentation Internet Search/Website Teacher Information Session Friend/Classmate Video Sign, posters, flyers at my school Other Have you traveled with an exchange program?*YesNoHave you hosted an exchange student?*YesNoDo you have any dietary restrictions or preferences?*YesNoIf you answered YES to Dietary Restrictions above please comment below.* Application Questions Please take the time to answer these questions thoroughly and thoughtfully. It is recommended that you save/print a copy of your answers before submitting your application. No more than 500 words per question.Student Essay QuestionsWhat is one extracurricular activity are you passionate about? How do you participate in that extracurricular activity? How often do you participate? What do you enjoy most about this activity?*What is one characteristic that you have that will be an asset for you in Costa Rica? How will this trait be beneficial to you and the group of students that travel with you to Costa Rica?*In your opinion, what are the most fascinating and/or interesting aspects of Costa Rica?*How will you be a good representative of the program, your family, community, school and country while traveling in Costa Rica?*Do you already have experience in cross-cultural situations? If so, what was the biggest challenge of the experience? What was the biggest benefit? If not, what do you anticipate being your biggest challenge with a cross-cultural experience?*Living in a new culture often requires adapting to different customs. How will you help yourself adjust to a new environment where you may be unfamiliar with the culture and language?*What do you hope to gain out of this experience? How does it fit with your future plans?*Use this section to describe who you are as a person and what has made you that way. This should be written clearly and concisely with an obvious starting and ending point. You can include any information in this essay that you feel it is necessary for the committee to know about you that hasn’t already been covered in previous questions. Maximum of 1,000 words. You might want to consider some of the following questions (however DO NOT limit yourself to these questions): Who and what are the biggest influences on you life? What is something you absolutely can’t live without? How do your friends and family describe you? What is your biggest goal in life? What is something that you want to do before you graduate high school? How do you like to spend your time outside of school? What is the last really good book you read for fun? What are you really passionate about? In what ways are you creative?Please include any additional information you feel may be helpful for the committee to know. Parent / Legal Guardian InformationPrimary Family Phone Number*Full Name* First Last Relation*OccupationEmail Cell Phone Number*Full Name First Last RelationOccupationEmail Cell Phone NumberTo whom should email correspondence be sent?*MotherFatherBothOtherParent's Marital StatusMarriedSeparatedDivorcedOther SituationIf OTHER is chosen above for email correspondence, please list the email address(s) below.*Emergency ContactFull Name* First Last Phone Number*Email Relation to Applicant* Upload a Photo Upload a recent, close-up, color photo of only yourself. If this presents difficulties the photo may be emailed to oregoncostaricaexchang[email protected] or included in the additional material to be mailed.File*DECLARATION: To the best of my knowledge and belief the information I have provided is true, correct, and complete. I have reviewed the mandatory orientation dates and understand my attendance at each one is required.Applicant E-Signature*Date* Date Format: MM slash DD slash YYYY DECLARATION: To the best of my knowledge and belief the information I have provided is true, correct, and complete. I have reviewed the mandatory orientation dates and understand my son/daughter's attendance at each one is required. I acknowledge that I am obligated and required to host a Costa Rican student prior to my travel or the following winter. I will also submit the contact information for another family who will host the winter following my travel. If I am a senior or personally unable to host, I commit to submitting contact information for two other families who are available and willing to host the following winter. This information will be submitted at the May overnight orientation, or I risk losing my traveler status. Parent / Guardian E-Signature*Date* Date Format: MM slash DD slash YYYY Captcha This iframe contains the logic required to handle Ajax powered Gravity Forms.
