First Name(s) As on Passport

Middle Name(s) As on Passport

Last Name(s) As on Passport

Gender Please select Male Female Non-binary

Date of Birth

Preferred Name

Pronouns Please select She / Her He / Him They / Them Prefer not to say

Address

City

State / Province Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Zip / Postal Code

County in State / Province

Address

City

State / Province Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Zip / Postal Code

County in State / Province

Student Lives With Please select Both Parents or Guardians Father or Guardian One Mother or Guardian Two Other

Parent / Guardian One Name (first and last)

Parent / Guardian Two Name (first and last)

Are all parents listed on the birth certificate available and willing to approve the student’s international travel?

Has there been a Divorce, Separation, or Adoption involving the student's natural parents?

Is custody and/or parental rights clearly spelled out in court approved documents?

Has there been a death, change of guardianship, waiver of parental rights, or is there some other block to parental signatures?

Does the student have a foreign birth certificate? (Outside the U.S. or Canada)

Does the student have two nationalities or passports?

Have either the student or parent(s) had a legal name change from what is listed on the birth certificate?

Do you think there are any other circumstances that will prevent ALL or ANY parent/guardian signatures?

Student Email Please do not use your school email address

Confirm Student Email

Parent / Guardian One Email

I consent to share my contact information with other exchange students traveling on the same route.

Parent / Guardian Two Email

Student Cell

Home Phone

Parent / Guardian One Cell

Parent / Guardian One Business

Parent / Guardian Two Cell

Parent / Guardian Two Business

Departure Airport - You can change this later Start typing your airport, you must select a value

Return Airport - You can change this later Start typing your airport, you must select a value