High School Abroad

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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)   --- Please Select --- Australia Brazil Costa Rica France Germany Japan Italy Spain

I'd like to travel to: (This is my second choice)   --- Please Select --- Australia Brazil Costa Rica France Germany Japan Italy Spain

I'd like to travel to: (This is my third choice)   --- Please Select --- Australia Brazil Costa Rica France Germany Japan Italy Spain

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)   --- Please Select --- Rennes, France Santiago, Dominican Republic Seville, Spain Shanghai, China Tokyo, Japan Valparaiso, Chile

I'd like to travel to: (This is my second choice)   --- Please Select --- Rennes, France Santiago, Dominican Republic Seville, Spain Shanghai, China Tokyo, Japan Valparaiso, Chile

I'd like to travel to: (This is my third choice)   --- Please Select --- Rennes, France Santiago, Dominican Republic Seville, Spain Shanghai, China Tokyo, Japan Valparaiso, Chile

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: