Form 7-2018        Page 2/2 To be filled out by the participating child and sent to the host school. Keep a copy at school.

INTERNATIONAL SCHOOL TO SCHOOL EXPERIENCE (ISSE)

BACKGROUND INFORMATION ON ADULT

Family (last) Name- _________________________        Personal (first) Name- __________________________

Nickname (if any)- __________________________       Age and birthdate (MM/DD/YY)- __________________

Email of chaperone- ______________________________________

CHAPERONE cell phone with country code - ________________________________

If you haven’t already, please download “WhatsApp” (or a similar chatting app) to use to communicate with the host school.

Education (degrees earned, fields of specialization): ____________________________________________________

Favorite activities: _________________________________________________________________________

How do you feel you might be used effectively in the classroom at the host school? ______________________

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Any dislikes your possible host family should know about? _________________________________________

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What other countries have you visited? ________________________________________________________

What languages do you speak? ______________________________________________________________

Have you ever participated in ISSE before, and if so, in what capacity? _______________________________

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What are you interested in ISSE? _____________________________________________________________

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Describe a typical weekend in your home. ______________________________________________________

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Please make any comments that should be considered in hosting you (for example, smoking or non-smoking, meat eater or vegetarian, any allergies, ect.) ____________________________________________________

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Attach a recent photo here.