Name: (First, Middle, Last)
Male      Female

Mailing address:
Home address: (if different)
City: State:
Zip/Postal Code:
Country:
Candidate's Email:
Telephone (country/city/area code/number):
Fax (country/city/area code/number):
Date of Birth: (month/day/year)
Country of Birth:
Country of Citizenship:

Academic Information

Name of your current school:
City: State:
Country:
Year of completion of secondary schooling:
Name of your recommender: (advisor, principal or teacher)
Name of your college counselor: (if different from recommender)
Title:
Your first language:
Other languages you speak

Family Information:

Please enter your Father's information in the box below:

Father's Full Name
Occupation
Street address (complete only if different from yours),
City, State, Zip/Postal Code, Country
Telephone and Fax, Father's Email address

Please enter your Mother's information in the box below:

Mother's Full Name
Occupation
Street address (complete only if different from yours),
City, State, Zip/Postal Code, Country
Telephone and Fax, Mother's Email address

Other person we might contact in case of emergency:
Relationship to candidate:
Telephone Day/Work:
Telephone Evening:
Name of person responsible for payment of program expenses:
Relationship to Candidate:

Essay

Please write a short essay about yourself and why you would like to spend the summer of 2009 with us in Paris. You may cut and paste it into the text box below or e-mail it as a separate file (text or ascii format only) to paris@study-serve.org

I will be e-mailing my essay
I am including my essay above.

Additional Information

Please describe your skills in spoken French:
Beginner   
Intermediate   
Advanced   
Fluent   

How did you first hear about Service Learning in Paris?

Do you have any medical problems or special needs about which we should know? If so, please explain below:

If accepted, in which study elective would you like to be enrolled:
Art and Architecture   
Art and Architecture (taught in French)   
French Politics & History
Literature and Writing   

Important: Press the submit button only ONCE.