ASIAMERICA
PRE-APPLICATION FORM
E-Mail Address:
Full Name: Male Female
Nationality: Religion:
Birth Place: Birthdate: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 19
Street Address: City:
Country: Zip Code:
Telephone: Fax:
Passport Number: Passport Issue Date: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Present School/University:
Highest Level of Education Completed: Middle School Some High School High School Some College College Graduate Masters Degree Doctoral Degree-PhD Professional Degree-MD,JD,etc Other
G.P.A. of Last 3 Years of School:
Father's Name: Occupation: Accounting Administrative Advertising Aerospace Architecture Automotive Banking Biotechnology Broadcasting Buyer Chemistry Clerical Collections College Graduate Computer Construction Consulting Copywriting Customer Service Designer Distribution Editorial Education Electronics Energy Engineering Environmental Finance Food Service Fundraising Graphic Design Health Care Hotel Human Resources Import Industrial Information Technology Insurance Internship Inventory Legal Maintenance Management Manufacturing Marketing Mechanical Medical Mortgage Nursing Operations Part-Time Pharmaceutical Production Professional Programmer Public Relations Purchasing Quality Real Estate Research Restaurant Retail Sales Science Secretarial Security Technical Telecommunications Telemarketing Training Transportation Travel Warehouse Other
Mother's Name: Occupation: Accounting Administrative Advertising Aerospace Architecture Automotive Banking Biotechnology Broadcasting Buyer Chemistry Clerical Collections College Graduate Computer Construction Consulting Copywriting Customer Service Designer Distribution Editorial Education Electronics Energy Engineering Environmental Finance Food Service Fundraising Graphic Design Health Care Hotel Human Resources Import Industrial Information Technology Insurance Internship Inventory Legal Maintenance Management Manufacturing Marketing Mechanical Medical Mortgage Nursing Operations Part-Time Pharmaceutical Production Professional Programmer Public Relations Purchasing Quality Real Estate Research Restaurant Retail Sales Science Secretarial Security Technical Telecommunications Telemarketing Training Transportation Travel Warehouse Other
Years of English Studied: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Other Languages: Hold Down Control Key to Select Multiple Languages Abkhaz Afrikaans Albanian Amharic Apache Arabic Armenian ASL (American Sign Language) Azerbaijani Balochi Basque Bengali Bhutanese Bikolano Blackfoot Bosnian Bulgarian Burmese Byelorussian Cambodian Cantonese Catalan Cebuano Chechen Cherokee Cheyenne Chickasaw Chinese Chinyanja Choctaw Cree Creole Czech Danish Dari Dutch Esperanto Estonian Finnish French Fula Gaelic - Irish Gaelic - Scottish Georgian German Greek Gujarati Hausa Hawaiian Hebrew Hiligaynon Hindi Hungarian Icelandic Igbo Ilokano Indonesian Inuktitut Italian Japanese Kapampangan Kazakh Kirghiz Khmer Kiowa Kirundi Kituba Korean Kurdish Ladino Lakota Laosian Latin Latvian Lenape Lingala Lithuanian Luganda Macedonian Malagasy Malay Maori Mohawk Mongolian More Navajo Nepali Norwegian Ojibwe Oromo Papiamento Passamaquoddy Persian Polish Portuguese Pulaar Punjabi Pushtu Romanian Russian Salish Samoan Serbo-Croat Shan Shona Sinhalese Slovak Slovenian Somali Sotho Spanish Swahili Swedish Tagalog Tajiki Tamil Telugu Thai Tibetan Tigrini Tlingit Turkmen Turkish Twi Ukrainian Urdu Ute Uzbek Vietnamese Waray Welsh Yiddish Yoruba Yup'ik Zulu Other
TOEFL Score: Test Date: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Clubs:
Hobbies:
Sports:
Leisure Activities:
Do You Have Relative or Friends Residing in the U.S.A.?: Yes No
If Yes, Which Cities/States?:
Which Programs Are You Interested In? (Hold Ctrl to Select Multiple Programs) AU PAIR in the USA CAMP COUNSELOR USA COMMUNITY COLLEGES USA HIGH SCHOOL & UNIVERSITY COMBO YEAR HIGH SCHOOL EXCHANGE YEAR PRIVATE HIGH SCHOOLS SHORT TERM HOMESTAY TEACH IN THE U.S.A. TEACHER-ADMINISTRATOR EXCHANGE PROGRAM TO THE U.S.A. SUMMER CAMPS U.S.A. SUMMER PROGRAMS U.S.A. UNIVERSITY SCHOLARSHIPS U.S.A WORK STUDY TRAVEL U.S.A
When Are You Planning To Apply & Participate? January February March April May June July August September October November December
Briefly Indicate Your Main Reasons For Applying:
What Type of Work Would You Like To Do in the Future?
Where Did You Hear About Our Programs?