Permanent Home Address:_______________________________________________ ____________________________________________________________________
Telephone: (____)_________________________
Social Security #:_______-____-________
Date of Birth:______/______/______
Place of Birth:_____________________________________________________
Passport Information: Name(as appears on passport): ___________________________________________________________________Passport Number:__________________
Date of Issue:_____/_____/_____
Expiration Date:____/____/____
ParentsÕ or GuardiansÕ Names:____________________________________________________________
Billing Address(if different from that of student): __________________________________________________________ ______________________________________________________________ ________________________________________________
FatherÕs Home Phone: (____)______________
Business: (____)______________
MotherÕs Home Phone: (____)______________
Business: (____)______________
GuardiansÕ Home Phone: (____)____________
Business: (____)______________
In case of emergency, if parents are not available, please notify:
Payment by: ___ Check #______ ___ Money Order #______
_____________________________ ______________ (Signature of Parent or Guardian) (Date) _____________________________ ______________ (Signature of Parent or Guardian) (Date) _____________________________ ______________ (Signature of Student) (Date)
STUDENT REGISTRATIONPART II
PART A. INTEREST INVENTORY:
1.) Briefly, what purpose will your study in France serve?_______________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
2.) What is your interpretation of a pro-active family environment?____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________
3.) List your particular interests, hobbies, and skills._______________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ________________
B. ESSAY:
In two hundred and fifty words discuss what French historic period, literary work, or person has inspired you to seek study in France? (Please type essay on a separate sheet of paper and attach to your application.)
