Online Student Application Form Please enable JavaScript in your browser to complete this form.Starting Quarter *FallWinterSpringSummerYear *Choose Year20362035203420332032203120302029202820272026202520242023202220212020Approximate Arrival Date *Choose a date or type in with format MM/DD/YYYY. If you are not sure yet, please let us know at least one week in advance.Flight InfoSchool *PrefixMr.Ms.Mrs.Name *FirstLastNicknameSex *MaleFemaleStudent's Parent's / Guardian's AddressStudents Birthday *Choose a date or type in with format MM/DD/YYYYStudent Age *Student Nationality *Student Native Language *Email *(Mobile) Phone Number *Please input only numbers (ex 123456789)Do you plan to bring your phone to the US? *YesNoSocial Media ID/Name *Such as FACEBOOK, LINE, KAKAOTALK, WECHAT, SKYPE, WhatsApp, etc. Will be used mainly to keep in contact with USAI staff and will be kept confidential.Are you applying through an agency? *YesNoAgency NameAgency AddressAgency CountryContact PersonAgency PhoneAgency EmailStudent Family Members (Name, Relationship, Age, Occupation) - 1 *Student Family Members (Name, Relationship, Age, Occupation) - 2tudent Family Members (Name, Relationship, Age, Occupation) - 3Student Family Members (Name, Relationship, Age, Occupation) - 4Student Family Members (Name, Relationship, Age, Occupation) - 5Student Family Members (Name, Relationship, Age, Occupation) - 6Do you have any mental, medical, physical requirements or special needs? *YesNoIf yes, please explain your requirements:Are you taking any medicine? *YesNoIf yes, please explain your medicine:Do you have any allergies? *FoodAnimalsMedicineOtherNoneIf yes, please explain your allergies:Do you prefer families with children? *YesNoNo PrefereceIf Yes, please indicate age range:Do you prefer families with pets? *YesNoNo PrefereceIf no, please indicate which pet(s):Interaction with Host Family *A lot of interactionModerate interactionMinimal interacitonDo you smoke? *YesNoPlease answer honestly. This is for placement purposes only.Do you plan to buy a car in the US?YesNoPlease rate your English level *I only know a few words and basic phrasesBeginner - can understand if spoken slowlyIntermediate - simple conversationsAdvanced - complicated conversationsFluent - speaking, reading and writing fluentlyAre you:ShyIndependentSocialOutgoingOpen-mindedTalkativeQuietHow would you describe yourself?What are your favorite foods?What foods do you not like?What are your hobbies and interests?ReadingWritingDrawingCookingMusicArtSportsMoviesWalkingExerciseHikingCampingVideo/Computer gamesOtherIf other, please describe:A Letter to Your Host Family *How long do you plan to stay in the USA? *How long do you plan to stay with your host family? *Previous travel abroad:Do you have any friends or relatives in the U.S. or Canada or Australia? *YesNoIf yes, please give their name, relationship to you, phone number, and address:How did you hear about SchoolInternetOther (please write other in text box)OtherContact Info While in U.S. - Email AddressContact Info While in U.S. - Mobile Phone NumberPlease input only numbers (ex 123456789)Do you need Airport Pickup Service? *YesNoArriving AirportWrite the name of the Airport you would be arriving at.Arrival DateLeave blank if undecided or type in with format MM/DD/YYYY.Time of ArrivalAirline abroad: you Agency Flight NumberFromDo you agree to Redish Homes Agency guidelines? *YesNoSubmit
