My name is:

My last name is:

I was born on: dd mm aa I am years old.

My e-mail is:

In case of emergency, you can contact:

Who is my:

Emergeny phone number:

Emergency e-mail:

I study at: I’m in grade.

My family members are... (name, relationship, occupation, and age).

I been outside of my home country.

* If yes, please tell what was most important to you about each experience.

Special needs? For example: diet, health, etc. YES ✔ NO

* If yes, please explain.

Allergies? For example: food, animals, insects, medicine, etc. YES NO ✔

* If yes, please explain.
Let me tell you about the activities I enjoy and take part in.
* (Sports, teams, clubs, hobbies, skills, etc.).

Let me tell you about my personality.

Students who come prepared to share part of their culture find it easier to become part of
their host family’s life, and to meet others in the community. It gives people something to
talk to you about. The things that I could share or teach about my culture are...

Please write a paragraph (minimum 10 lines) telling us any extra information we should
know about you that would help us place you with your host family. Include: background
on who you are, what you like such as music, sports, hobbies, etc., what your family in
Colombia is like; what you’re expecting from this program, and why you want to do it. The
families in the U.S want to know as much as possible about you.

Please send this form to:

intercambio@pctcolombia.net
If you have any questions, please contact us.