AFX Student Exchange

Candidate Information

Last Name (as it appears on your passport)*

Given Names (as they appear on your passport)*

Gender*

Birth Date*

DayMonthYear

Student Contact E-mail*

an email address we can contact the student on when they are on exchange

Student Mobile Number*

The AFX Program you would like to particpate in*

How did you hear about AFX Student Exchange*

Address

Number and Street*

Suburb*

Post Code*

State*

Country*

Home Phone Number*

Area CodePhone Number

Family

Main Contact E-mail*

Please provide the email address that is best contact for the candidate's parents / guardians. This will be the main contact email for AFX Student Exchange.

Parent/Guardian 1 Name*

Parent/Guardian 1 Occupation*

Parent/Guardian 1 Email Address*

Parent/Guardian 1 Date of Birth

DayMonthYear

Parent/Guardian 1 Contact Number:*

Parent/Guardian 2 Name*

Parent/Guardian 2 Occupation*

Parent/Guardian 2 Email Address*

Parent/Guardian 2 Contact Number*

Parent/Guardian 2 Date of Birth

DayMonthYear

Describe your family*

who lives with you, brothers, sisters, names and ages.

Emergency Contact details*

Must be an adult other than the parents/guardians listed above.

School

Your School Name:*

The name of your school

Your school year level*

The name of your French teacher*

Email of your French teacher*

example@example.com

Your School Postal Address

Profile

Describe Your motivation for participating in this program*

Your Hobbies and Interests*

When you host your French correspondent, what sort of activities would you like to do with them?*

Describe your ideal exchange correspondent*

Will the French Student have their own room when staying with you?*

It is important that the French student has their own room to stay in whilst they are staying with you

Do you practice a religion?

If yes please describe your practice?

Describe the rules in you home, as they apply to you*

Do you have any pets? If so describe them:*

For how many years have you been studing French

How would you rate your French language skills (1 being complete beginner, 10 being native speaker.*

Have you done any overseas or independent travel before?*

Passport Number*

Passport Date of Issue*

MonthDayYear

Passport Date of Expiry*

MonthDayYear

Nationality on Passport*

Health Details

Height (cm)

Weight (kg)

Do you have any allergies? Do you have any rextrictions on the food you can eat?*

Do you smoke?*

Smoking during any of our high school programs is against the rules.

Do you have any health conditions? Are there any activites you can't participate in (be specific)?*

Anything that you suffer from regularly, or have ongoing treatment for

Any additional information that you think might be important for AFX to consider:

Passport Details