High School Abroad

 
Fields marked in red are required.
First Name:
Last Name:
Company Name:
Title:
Address 1:
Address 2:
City:
State:
Zip:
Country:
Phone:   Use Format: xxx-xxx-xxxx
Alternate Phone:   Use Format: xxx-xxx-xxxx
Cell Phone:   Use Format: xxx-xxx-xxxx
Email:
Fax:   Use Format: xxx-xxx-xxxx
Company Website:   http://


Additional Information about you
 I am a:
  High school student Parent
  School Counselor Teacher
  Independent Counselor    
 Parent/Guardian E-Mail Address:
 
 Applicant date of birth:
     Use format: mm/dd/yyyy
 Gender:
  Female Male
 Approximate GPA:
 
 Foreign Language Experience (Language(s) and time studied):
 
 My current year in school:
  8 9 10 11 12
  12+          
   Month I will Graduate: 
   Year I will Graduate: 
 
Tell us about your school
 Name of my high school:
 
 Street Address:
 
 City:
 
 State:
 
 Zip:
 
 School telephone #:
 
 My Guidance Counselor's name:
 
 
I'm interested in High School Abroad
(I'm in high school now)
 I'd like to travel to: (This is my first choice)
 
 I'd like to travel to: (This is my second choice)
 
 I'd like to travel to: (This is my third choice)
 
 I'd like to go for:
  Semester Academic Year
 I'd like to start:
  Jan/Feb 2008 Aug/Sept 2008
  Jan/Feb 2009 Aug/Sept 2009
 
I am interested in a Gap Year Abroad
(I will have graduated before I go abroad)
 I'd like to travel to: (This is my first choice)
 
 I'd like to travel to: (This is my second choice)
 
 I'd like to travel to: (This is my third choice)
 
 I'd like to go for: (Semesters range from 2.5 to 4 months, Academic Years range from 8 to 10 months)
  Semester Academic Year
 I'd like to start:
  Jan/Feb 2008 Aug/Sept 2008
  Jan/Feb 2009 Aug/Sept 2009
 I'd like to study in a high school as a 13th year.
  Yes
  No
 
How did you hear about CIEE?
 Need more information?
  Please have someone call me
  Please send more information by e-mail
 How did you hear about us?
  Internet Parent / Friend
  Exchange Student School Counselor / Teacher
  Other CIEE visited my school
   If Other, Please specify: 
 
What else do you want to tell us?
 Additional Comments: