Form 6-2018        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 CHILDREN

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

Nickname (if any)- _____________________       Age and birthdate- ___________________

Delegate email address- ______________________________________

Delegate cell phone with country code (if you have one)- ________________________________

Name of Guardian 1-__________________________  Relationship to candidate- _______________________

Email- ___________________________________________________

Occupation- ____________________ Cell phone with country code- ______________________

Name of Guardian 2-__________________________  Relationship to candidate- _______________________

Email- ___________________________________________________

Occupation- ____________________ Cell phone with country code- ______________________

List other adults living in the home(s) and their relationship to the candidate-

________________________________________________________________________________________

List siblings and their ages- ________________________________________________________________________________________

What do you most enjoy about school?_________________________________________________________

Which countries have you visited other than your own? ____________________________________________

Do you know anyone who has participated in ISSE before? If so, who, and how were they involved? ________

________________________________________________________________________________________

What languages do you speak? ______________________________________________________________

Do you have any allergies (pets, medicines, plants, ect.) or medical concerns that should be taken into consideration?  ___________________________________________________________________________

________________________________________________________________________________________

Attach a letter to your host family answering the following questions-

Please check all of the activities you enjoy and participate in:

Please check all of the organized sports you participate in:

Mark 5 traits most closely aligned with you so we can match you with the best possible host family: