Exchange Application

BRIGHTON/ZIEBICE SISTER CITIES EXCHANGE APPLICATION

* Indicates required field

Name *

First

Last

Email *

Home Phone *

Cell Phone *

Address *

City *

State *

Zip *

Birthday *

Grade *

Current School *

Passport # *

Passport Issue Date *

Parent/Guardians Names *

Sibling Names *

Names of students your family has hosted *

Will you & your family commit to hosting? *

Yes No

Leisure time *

School activities *

Community activities *

Volunteer and/or work *

Musical Instrument *

Athletics: I.E. Running *

Favorite High school classes *

In a paragraph, please address the following questions:

What do you hope to gain from this experience? *

how will you and your family participate in our organization in the next few years? *

Allergies (food and/or medicine) *

Medical Concerns *

List all medications *

By typing my name I warrant the truthfulness of the information provided in this application.

Electronic Signature *

Submit