Fredericksburg Academy International Student Application Supplement

Thank you for applying to be a studentat Fredericksburg Academy! Please be sure to fill in all applicable fields. Your application is very important. It should reflect who you are—your interests, activities, likes and dislikes, and whatyou hope to gain from the program. Neatly type or print legibly in BLACK ink in English.Responses to all questions should be honest and detailed.

Legal First Name / Middle Name / Last Name / Gender / Employer/School
Birth Date (MM/DD/YY) / Country of Birth / Level of Education / Contact Phone / Contact Email
Parent Information

Parent 1 (Primary Contact Person other than Student)

Name / Occupation / Job Title / Employer / Primary Email / Mobile Phone / Business Phone / Fax

Parent 2

Name / Occupation / Job Title / Employer / Primary Email / Mobile Phone / Business Phone / Fax
Residence and Community

Residential Address

Address / Postal Code
City/Province / Country
Home Phone / Home Fax

Mailing Address, leave blank if same as above

Address / Postal Code
City/Province / Country
Home Phone / Home Fax
  1. Type of Home ______(e.g. townhome, single family, apartment, etc.)
  2. Briefly describe your home (number of rooms, bedrooms, yard, etc.)
  1. Briefly describe the neighborhood you live in (Is it gated, do you have neighbors, etc.?)
  1. Is your home in a: City?______Suburb?_____ Town?____ Village?______Rural Area?______
  2. Population of your Community______
  3. Name of Nearest City______Distance to Nearest City______
  4. Briefly describe your community

School

Distance from Home to School: Miles or Kilometers______Minutes______

How do you get to school? Bus/Public Transportation____ Car_____ Walk______Other______

What, if any, family members attend school with you______

What, if any, family members are affiliated with the school as an employee______

Placement Criteria

Do you smoke? ______

Inside or outside of the house? ______

Will you agree to abstain from smoking while on program if you are under age? (18 is the legal age for tobacco in the United States)______

Do you drink alcohol? ______

Will you agree to abstain from drinking while on program? (21 is the legal age for alcohol in the United States)______

Do you have any pet allergies? ______

Please list which animals you are allergic to:

Do you have any pet fears? ______Can you adjust to pets in the home? ______

Please explain above two responses:

Do you follow any dietary restrictions? _____

Do you have any food allergies?______

Please list dietary preferences and food allergies (if applicable):

Would you feel comfortable living in a family who follows a particular dietary restriction (such as food allergies, Kosher, vegetarian, vegan, gluten free, etc.)? ______

Would you feel comfortable living in a family with someone who smokes? _____

What is the primary language spoken at home?______

What other languages are spoken at home? ______

What languages are known by family members, and with what fluency?

Have you ever been hosted through another exchange organization?______

If yes, please list organization(s) and dates of exchange

Have you ever traveled outside your home country? ____

Briefly mention with whom, which countries and for how long.

Have you ever lived outside your home country? _____

Please specify which countries and for how long.

Have you ever traveled to the United States? ____

Briefly mention when, specifically where, and for how long.

What is your religious affiliation, if any?______

How often do you participate in religious services or activities?

If you attend religious services or activities, do you expect to continue while abroad? _____

Would you have difficulty living in a family whose religious beliefs were different of your own? _____

Describe any special circumstances you have (eating habits, unusual sleeping hours, etc.) to which your host family will need to adapt.

Part 2- Confidential Form

Instructions:
Please fill in all applicable fields.

Have you received professional counseling within the past five years?_____
If yes, please describe the dates of the treatment, how the situation affects your life and your family members’ everyday lives, and if you are currently in a stable condition.

Do you have a serious illness, chronic medical condition, or physical or mental disability? _____
If yes, give a brief description.

Have you ever been charged with any crime? ______
If yes, please give a brief explanation including date of charges, reason for charge, and outcome.

Have you ever had your driver’s license suspended or revoked?______
If yes, please give brief explanation which gives date license was revoked, reason, and date of reinstatement.

Part 3- Student and Family Description

Why are you interested in being a student at Fredericksburg Academy?

Please indicate your major interests, hobbies and activities. Include any sports or fitness activities, religious activities, volunteering, etc.

Describe each member in your family (including yourself) in terms of personality, activities, achievements and interests, etc.

Describe a typical weekday in your family.

Describe a typical weekend in your home.

When you do something special on a weekend, what might you do?

Describe any common family activities in a week or in the month. This can include: Swim Meets on Fridays, Church on Sundays, Monthly Movie Night, etc. Be specific about who attends and how often it occurs.

How does your family celebrate birthdays? What specific things are your family traditions for birthdays?

What other holiday traditions does your family celebrate or take part in? Describe the different holidays you celebrate and how you celebrate them. Be sure to mention any particular traditions.

Describe what is important to your family. What are your family values?

What are some of your family’s rules? Think about the unspoken rules or actions you might have as well. Are you required to check in with parents when you are going somewhere different, do you answer the phone if you are the closest? Does everyone sit and watch the news together after dinner?

Describe your expectations regarding the responsibilities and behavior you will demonstrate while in your host family’s home. What chores will you participate in, curfew, computer time, etc.

What personal expenses do you expect touse your own money for while in your host family’s home? (i.e. shampoo, toothpaste)

How do you envision your involvement in your host family?

How do you hope to help ease the transition into your host family?

What things would you like to do over the year with your host family? What special trips or “dream” excursions do you wishyou could make in the USA?

What would you like to learn as a student about your host family and the USA?

What are you most excited about?

Part 4- Host Family Letter

Please write and attach a letter to your host family telling them about your family and yourself. Write something about yourself and what you are excited for, and any other personal things or messages you would like to relay to your host family. Be sure to talk about family responsibilities and things your family enjoys doing together. Also please sendor attach some photos of you and your family for your host family with captions describing the pictures. You can send the pictures to . These pictures could be your family and you doing everyday activities, any pets, the home or your room, or anything else you would like to share with them before you arrive.

Signature of ApplicantDate

Signature of Parent 1Date

Signature of Parent 2Date

Notice: Fredericksburg Academy reserves the right at all times to modify its admission requirements and to discontinue, modify, or change its educational programs when it determines that it is in the best interest of the school to do so.

Fredericksburg AcademyOffice of Admission

10800 Academy Drive

Fredericksburg, Virginia 22408 540.898.0020·Fax: 540.898.8951 ·

There shall be no discrimination by the School in the selection of the Board of Trustees, the employment of personnel, in theadmissionof students, or in the administration of the School programming because of race, color, religion, national origin, sex, age, sexual orientation, or handicapped status in violation of existing state or federal law or regulations.

FA International Student Application Supplement

Page 1 of 10