Adolesco | Adolesco | Main Application

2.2_NA

Step 1 of 13

Candidate's LAST name

Candidate's FIRST name

Known as (if different)

Family Home and Contact Information

Mother/Parent #1 Name

First Last

Mother/Parent #1 Phone Number

Mother/Parent# 1 Work Phone (if different)

When is the best time to reach you? (for example, 7am – 5pm, or after 3 pm)

Until what time may we reach you in the evening?

Father/Parent #2 Name

First Last

Father/Parent #2 Phone Number

Father/Parent #2 Work Phone (if different)

When is the best time to reach you? (for example, 7am – 5pm, or after 3 pm)

Until what time may we reach you in the evening?

Candidate has more than one home address

Please answer yes only if the candidate has custodial parents that live separately and the candidate regularly moves back and forth between two homes.

Street Address (Candidate's Primary Home Address)

NOTE: If the candidate splits their time between two homes (custodial parents that live separately) please complete this section with the address at which the candidate spends MOST of their time. Put the second address on the page for ‘Additional Parent’ that can be found towards the end of the application.

Address Line 2

City, State

Zip

This field is hidden when viewing the form

Département (pas le code)

Nearest city

For example: 20 miles from Denver

Country

Home Phone (landline), if applicable

Mother/Parent #1 Email address:

Father/Parent #2 Email address:

Candidate's Email address:

Candidate

Birthdate

Month

Day

Year

Place of Birth

Nationality

Sex/Gender

Height (in feet and inches; e.g., 4'3")

Weight (lbs)

Is the child adopted?

Parent: Please give us a short summary of candidate's personality (character, sensitivity, relationship with others, etc.)

Complete this section WITH the young person concerned

Do they practice a religion or other form of spirituality?

Do they like to read?

Do they play an instrument or sing? For how many years?

What kind of outings do they enjoy (nature, museum, library, cinema, etc.)?

Member of any clubs or workshops (art, sculpture, creative writing, scouts, etc.)?

Do they play a sport with a team or club? From what age/for how long?

What sports/physical activities do they participate in on their own or with family and friends?

Are they competitive?

Do they know how to swim?

Yes

Swimming ability:

On average, how many hours of sports per week?

Favorite out-of-school activities (games, reading, relaxing, movies, TV, cooking, video games, hanging out with friends, etc.):

Ask candidate this question: "Do you think that you can leave your cellphone behind during your stay abroad?"

Yes, as I don’t have a cellphone

Yes, easily

Maybe, it will not be easy

No, I use it all the time. I have no plan to leave it behind.

Has your child already been away from home (without parents)? How long?

Which of the following describe your child?

Tidy

Messy

Punctual

Dreamer

Realistic

Sensitive

Creative

Determined

Emotional

Chatterbox

Thoughtful

Spontaneous

Smiling

Reserved

Active

Curious

Calm

Shy

Scatterbrain

Select all that apply

Does your child think they have any faults? Which ones?

And how about their BEST qualities?

Health Questionnaire

This section may be removed by the host family in case of emergency.

Child's Full Name

First Last

Date of Birth

Vaccinations

Note: In the date fields below, please indicate the MOST RECENT vaccination (initial vaccine or booster, whichever applies).

Diptheria

Vaccine

Booster

Not received

Date (Diptheria vaccine)

Pertussis (Whooping Cough)

Vaccine/Booster

Illness

Not Received

Date (Pertussis Vaccine or Illness)

Tetanus

Vaccine

Booster

Not Received

Date (Tetanus Vaccine)

Polio

Vaccine

Booster

Not Received

Date (Polio Vaccine)

Measles

Vaccine/Booster

Illness

Not received

Date (Measles Vaccine or Illness)

Mumps

Vaccine/Booster

Illness

Not received

Date (Mumps Vaccine or Illness)

Rubella

Vaccine/Booster

Illness

Not received

Date (Rubella Vaccine or Illness)

Chickenpox

Vaccine/Booster

Illness

Not received

Date (Chickenpox Vaccine or Illness)

Tuberculosis

Vaccine

Booster

Not received

Date (BCG Vaccine)

Has the child undergone any form of surgery?

Yes

Comments

Have they ever had a local or general anesthetic? Any complications? If yes, explain in the comments field.

Yes

Comments

Are they allergic to any medication? If yes, please give a detailed explanation in the comment field.

Yes

Comments

Any food allergies? If yes, please explain in the comments field.

Yes

Comments

Have they ever had a seizure?

Yes

Comments

Do they have asthma?

Yes

Comments

Do they have any sleep problems? Difficulty falling asleep? Nightmares? Sleepwalking? If yes, please give a detailed explanation in the comments field.

Yes

Comments

Any problems with bed-wetting?

Yes

Comments

Do they often have headaches?

Yes

Comments

Do they often have stomachaches?

Yes

Comments

Constipation?

Yes

Comments

Any skin problems?

Yes

Comments

Have they suffered from giddiness and/or fainting, with loss of consciousness?

Yes

Comments

Do they take any medication regularly?

Yes

Comments

Do they wear glasses? If yes, all the time or only for certain activities (reading, watching TV, etc.)?

Yes

Comments

Do they have orthodontic braces?

Yes

Comments

Have they been diagnosed with any illness not already mentioned?

Yes

Comments

Any medical reason they can't participate in sports or other athletic activity?

Yes

Comments

Have their periods started yet?

Yes

Comments

Blood type, if known

Other remarks: allergies, headaches, eating disorder (now or in the past), travel sickness, hearing problems, dyslexia, etc.

Has your child ever consulted with a therapist, psychologist, or psychiatrist? If so, please explain. Also, please list any psychiatric medications taken regularly or as needed.

Please describe any alternative medicine or methods to treat your children when they are unwell.

Does your family or the candidate have any special eating habits (vegetarian, vegan, kosher, etc.)? Any food your child really doesn't like?

School

Is your child homeschooled?

Yes

Current School Level

Public or Private

Co-Ed/Girls/Boys

Approximate number of students in the school

School Name

Street Address

Address Line 2

City

Zip

Phone

Email (if applicable)

Website

Principal's Name

This field is hidden when viewing the form

Form/Main teacher's name

Child's current grade

Candidate's Academic Ability

Please be objective

Any details you would like share regarding child's school performance:

Time needed to travel to school

Means of transport to and from school

This field is hidden when viewing the form

Votre établissement scolaire est en Zone:

This field is hidden when viewing the form

C'est à dire dans l'Académie de:

For the coming school year (complete only if different from the current year):

Name of School

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

First Name

Gender

Birthdate

Still living at home?

Does candidate have a twin?

Is there another child on the way?

Do any of the siblings have any mental or physical disabilities or significant health problems? Please describe.

Briefly describe the relationship between the exchange candidate and their siblings.

Mother/Step-Mother/Other Parent

Last Name

This field is hidden when viewing the form

Maiden Name

First Name

Known As (if different)

Date of Birth

Month

Day

Year

Divorced?

Separated?

Do you have any disabilites or health problems?

Do you smoke?

If yes, how many per day?

In the house?

Religion? Practicing? Other form of spirituality?

How would you describe your character?

Occupation (at present); Please give details, including hours and arrangements for child care if applicable

Hobbies and Interests:

Your level of education:

Is English your first language?

How well do you speak:

French

German

Italian

Spanish

As a child, did you ever spend time in a foreign country?

If yes, where and for how long?

Father/Step-Father/Other Parent

Last Name

First Name

Known As (if different)

Date of Birth

Month

Day

Year

Divorced?

Separated?

Do you have any disabilites or health problems?

Do you smoke?

If yes, how many per day?

In the house?

Religion? Practicing? Other form of spirituality?

How would you describe your character?

Occupation (at present); Please give details, including hours and arrangements for child care if applicable)

Hobbies and Interests:

Your level of education:

Is English your first language?

How well do you speak:

French

German

Italian

Spanish

Did you ever spend any time in a foreign country as a child/teenager?

If yes, where and for how long?

The Family Home

Your home is:

This field is hidden when viewing the form

Home, other:

…located on:

and is:

If an apartment, what floor?

Do you have a yard/garden?

Approximate size of yard/garden:

While hosting, the exchange partner (visiting) child will…

If the children will share, approximately how large is the room that will be shared?

Will they have the choice between sharing or having a room of their own?

Number of people living in the house during the week?

and on the weekend?

Does someone regularly come into the home to do housework or other chores?

If yes, please give details (name, age, what they do, how frequently, etc.):

How many cars do you have?

This field is hidden when viewing the form

How many motorcycles/scooters?

How many bicycles?

Any pets? What kind(s) and how many?

Do you have (select all that apply)…

Television

DVD player

Piano

Video Game System

Do you have any firearms in the house?

If yes, please explain:

Insurance

Personal Liability Insurance Company

Company's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Liability Insurance Policy Number

Do you have any form of private health insurance?

Daily Life

In order to better understand your family and for the exchange child to better adapt to a new family, it helps to know something about your daily habits and expectations. There are no right or wrong answers to these questions, so please be honest

When your children misbehave or do something against the rules, how do you discipline them? Do you tend to let things sort themselves out or do you react immediately?

How do you react when your child oversteps the boundaries? What are the sanctions or consequences?

Do you have meals together as a family? Which ones? During the week? On the weekends?

Are you generally strict or lenient about table manners?

How often do your children eat snacks and desserts?

And are you generally strict or lenient about behavior in the house?

Describe your children's typical bedtime/waking schedule:

Do you supervise children's homework, music practice, etc….?

Do your children have access to a computer at home? Where is it located in the house? Is access to the internet monitored?

In their room, your child has… (select all that apply)

Television

Desktop Computer

Laptop

Tablet

Does your child have a cell phone?

Are there time limits on use of electronics? About how much time does your child spend in front of the screen per day?

Describe an 'ordinary' family day:

What household chores do you expect your children to do (making beds, washing up, cleaning, etc.)? What would you expect of the exchange child?

Does your child enjoy being part of a group? Do they respect others and their possessions?

Is the candidate allowed to leave the house unaccompanied, either during the day or at night? If yes, please describe:

How much freedom (going out in the evening, curfew, etc.) will be offered to the exchange youngster?

Is your child allowed to drink and or smoke or spend time with friends who do?

Do you know your child's friends well?

Do you give your child a regular allowance? If yes, how much?

How often does your child see their grandparents?

Do you allow your children to travel by themselves? If yes, please describe:

How would you describe a good exchange family for your child?

What kinds of family outings/activities would you plan to do while hosting?

Choice of Country

Please rank your choice of country/destination by assigning a number to each option below (choices should add up to 100): for example, if you are interested in France and Germany equally, assign 50 (percent) to France and 50 (percent) to Germany.

Germany

Please enter a number from 0 to 100.

This field is hidden when viewing the form

English in Europe

Please enter a number from 0 to 100

This field is hidden when viewing the form

English in America

Please enter a number from 0 to 100.

Spain

Please enter a number from 0 to 100.

France

Please enter a number from 0 to 100.

Italy

Please enter a number from 0 to 100.

Please explain your choice/preference. Remember: the more flexible you are the easier it is for us to find a match for your child.

For how long would your child like to travel?

Your child prefers an exchange partner that is:

If your child is 16 or older, please indicate the date of their 18th birthday here:

Personal References

Please give us the names and contact information for two people who know your child and your family well but who are not related to you or your child. We will contact them, please verify that phone numbers and email addresses are correct.

Name

First Last

This field is hidden when viewing the form

Occupation

Phone

Name

First Last

This field is hidden when viewing the form

Occupation

Phone

Previous Exchange Experience

Has your family already taken part in an exchange?

If yes, with what organization?

With their permission, please write below the name and email address for each foreign family; we may contact them.

How did you originally hear about Adolesco? Please be as precise as possible.

Additional Parent

Please complete this section for a parent that does not live with the candidate.

Last Name

First Name

Known As (if different)

Date of Birth

Month

Day

Year

Do you have any disabilites or health problems?

Do you smoke?

If yes, how many per day?

In the house?

Religion? Practicing? Other form of spirituality?

How would you describe your character?

Occupation (at present); Please give details, including hours and arrangements for child care if applicable)

Hobbies and Interests:

Your level of education:

Is English your first language?

How well do you speak:

French

German

Italian

Spanish

Did you ever spend any time in a foreign country as a child/teenager?

If yes, where and for how long?

Data Protection

Select ACCEPT or DECLINE to the questions below; see our data protection policy on our website: www.adolesco.org

Mother/Parent #1 Name

Today's Date

Information Use(Required)

By submitting this document, I agree that the information included here and/or in future e-mail communication with Adolesco may be used to find an exchange partner for my child, to work with other Adolesco representatives during the exchange, and to contact me.

Pre-Application(Required)

I accept that the pre-application previously submitted may be sent to a local Adolesco representative for the purpose of the ‘home visit’ (required as part of the complete application for an Adolesco exchange).

Future Communication(Required)

If an exchange is offered to my child, I agree to be contacted by Adolesco in the future to provide an assessment of the exchange and/or to be asked to communicate with or visit potential exchange candidates and families.

Updates(Required)

I agree to receive future updates about Adolesco, community outreach events, and new destinations.

Father/Parent #2 Name

Today's Date

Information Use(Required)

Pre-Application(Required)

Future Communication(Required)

Updates(Required)

I agree to receive future updates about Adolesco, community outreach events, and new destinations.

Suche

Search for:

Adolesco on Facebook

Adolesco International Youth Exchange

2 months ago

Learn languages with @Adolesco.org!!! #English #french #german #italian #spain #languageexchange #languagelearning #CulturalExchange

www.facebook.com/share/v/195pA5PZqs/ ...

Play

View on Facebook (opens in a new tab)

· Share

Share on Facebook (opens in a new tab) Share on Twitter (opens in a new tab) Share on LinkedIn (opens in a new tab) Share by Email (opens in a new tab)

View Comments Like reaction Love reaction Reactions: 6 Shares: 2 Comments: 2

2 CommentsComment on Facebook

Adolesco International Youth Exchange

2 months ago

🇮🇹 Envie d’un échange linguistique avec l’Italie ? 🇫🇷

Adolesco vous présente Marta, 17 ans, qui vit près de la mer Adriatique 🌊
Sportive, solaire et toujours partante pour bouger : natation, triathlon, foot ⚽🏊‍♀️

Quand elle ne travaille pas comme sauveteuse l’été, elle aime aussi les films 🎬, la mode 👗 et le makeup 💄

💬 Elle cherche un/une partenaire français(e) pour échanger, progresser en langue et découvrir une nouvelle culture !

📩 Intéressé·e ? Écris-nous en DM ou contacte l'asso ! Mail: [email protected]

#EchangeLinguistique #LanguageExchange #FranceItalie #Correspondant #ItalianCulture LearnFrench LearnItalian YouthExchange ...

This content isn't available right now

When this happens, it's usually because the owner only shared it with a small group of people, changed who can see it or it's been deleted.

View on Facebook (opens in a new tab)

· Share

Share on Facebook (opens in a new tab) Share on Twitter (opens in a new tab) Share on LinkedIn (opens in a new tab) Share by Email (opens in a new tab)

View Comments Like reaction Reactions: 7 Shares: 0 Comments: 0

0 CommentsComment on Facebook

Adolesco International Youth Exchange

2 months ago

✨ Cuatro jóvenes alemanas con ganas de vivir una experiencia internacional inolvidable.

Sophie, Marietta, Milla y Nele buscan la oportunidad de conocer nuestra cultura, mejorar el idioma y formar parte de una familia anfitriona.

¿Te gustaría abrir las puertas de tu hogar y compartir una experiencia única? ❤️🌍

✍¡ESCRÍBENOS y te explicaremos el proceso!

#intercambiocultural #FamiliaAnfitriona #EstudiantesDeIntercambio #ALEMANIA #experienciainternacional #youthexchange #hostfamily #IntercambioEstudiantil #CulturaSinFronteras #AventuraInternacional

www.facebook.com/share/p/195R3idjU2/ ...

View on Facebook (opens in a new tab)

· Share

Share on Facebook (opens in a new tab) Share on Twitter (opens in a new tab) Share on LinkedIn (opens in a new tab) Share by Email (opens in a new tab)

View Comments Like reaction Reactions: 6 Shares: 0 Comments: 0

0 CommentsComment on Facebook

Explore

France
Germany
Spain
Italy