GERMAN-AMERICAN PARTNERSHIP PROGRAM

Stromberg-Gymnasium Vaihingen/ Enz- Elizabethtown Area High School

Student Information Form

Please fill in the form in English and send it to:


and

I. Personal Data

Family Name
First Name
Age
Sex
Date of birth
Address
Telephone
E-Mail
Father’s occupation
Mother’s occupation
Brothers (number/ ages)
Sisters (number/ ages)
Religion

II. Personal Habits or Preferences

Is religion an important part of your life? (x)
yes / no
Do you attend religious service regularly? (x)
yes / no
Are you used to drinking alcoholic beverages? (x)
yes / no
Do you smoke? (x)
yes / no / occasionally
Are you a member of an association, club or organisation? If so, which one(s)?
Do you have a part-time job? If so, what do you do?
Do you have pets at home? If so, which one(s)?
To which animals do you object?

III. Spare time activities

What type of literature do you read?
What kinds of sport do you do? Are you in a team?
What were your favorite movies in recent time?
What kind of music do you like/ listen to?
Do you play an instrument or sing in a choir?
Do you have other special interests or hobbies?

IV. School

What are your favorite subjects at school?
Have you ever been on a school exchange before? (e.g. GB/ France) If yes, where?
Which languages would you like to continue in J1? English, French and/or Spanish?
Are you interested in a special area of knowledge, about which you would like to learn more during your stay in Elizabethtown?

V. Travel experience

What trips to foreign countries have you taken in the past years?
What was the purpose of these trips and what did you learn from them?
Have you ever been a guest in a foreign family? If so, when and for how long?

VI. Personality Information

Have you already decided on career choices and / or courses of study?

Please describe yourself using the following marking scale (x)

rarely/slightly / moderately/sometimes / often/very much
adventurous
calm
creative
group-oriented
individualistic
open-minded
organized
patient
serious
shy
talkative

VII. Staying abroad (x)

I would prefer to be hosted by / a boy / a girl / either
Would you mind sharing a room with a host brother or sister? / yes / no
I would prefer being hosted by / a large / a small family / either
I am able to offer home hospitality to a student from the American partner school during their visit in Germany.
a boy / a girl / Either

VIII. Information concerning health

Must you take a certain medication regularly? If so, which?
Are you allergic to animals or plants? If so, to which?
What has to be done, if the allergy arises?
Must you follow a special diet? If so, please, describe.

IX. Further Information

Further information which you consider important for your host and host family.

X. The visit of your exchange partner

Please write down here, what you expect from your partner when he/she comes to visit you. (What should he/she be interested in? What will he/she have to be prepared to do? What would you like to do together?)

XI. Staying in your host family in the USA

Please write down what you expect from participating in this program and what you hope to achieve by staying in your host family and in Elizabethtown.

XII. Picture

Insert a digital picture of yourself here