Gender – *
At your school, you are currently a … *
Home Phone Number with country’s code- *
Your Cell Phone Number with country’s code-
Are you a U.S. Citizen? *
Please upload the first page of your passport
Sponsor’s Name: *
Sponsor’s Address if different from your personal address:
Sponsor’s City: *
Sponsor’s State: *
Sponsor’s Phone Number: *
Total cost of program? *
Amount to be covered by U.S. Government? *
Amount to be covered by Exchange Visitor’s Government? *
Amount to be covered by Exchange Visitor’s University? *
Amount to be covered by Exchange Visitor? *
Do you currently have a U.S. Visa? *
Do you currently have Medical Insurance which covers you while in the U.S.A.? *
This is to ensure that students have accident insurance and major medical expenses, including funeral expenses and repatriation of remains. We recommend buying it in country of origin. “As of May 15, 2015, minimum coverage must provide medical benefits of at least $100,000 per accident or illness; repatriation of remains in the amount of $25,000; expenses associated with medical evacuation to the exchange visitor’s home country in the amount of $50,000; and deductibles cannot exceed $500 per accident or illness (Section 62.14(a)). Inadequate insurance coverage may be catastrophic for an individual exchange visitor.” If the above medical insurance coverage is not purchased prior to arrival and since full health insurance is required for all international students, Medical Insurance will be added to your tuition and costs depends on age.
Emergency Contact Full Name: *
Emergency Contact Phone Number with Country’s Code:
T-Shirt Size – *
Small – Medium – Large – Extra Large – 2x Large – 3x Large –
