Application Form for STUDENT EXCHANGE PROGRAMME 2019-2020 1 1.

About the Student Full legal

Name as it appears on passport or birth certificate (use all capital letters) Nick Name Gender Male
Female Enrollment No: Class: Section: Date of Birth (DD/MM/YYYY): Nationality: Religion: Mother
Tongue: Languages Known Native Language: Non Native Language(s) Years Studied Proficiency (indicate
Poor, Fair, Good, or Fluent) Speaking Reading Writing 2. About Host Family Head of family Name :
Address : Land Line: Mobile No: Email Address : Nearest P.S. Name : Contact No. Details of Parents: 1)
Father: Age: Occupation: Name of Employer: Email Address : PAN/AADHAAR No: Work Ph. No. Cell
Phone: 2) Mother: Age: Occupation: Name of Employer: Email Address : PAN/AADHAAR No: Work Ph.
No. Cell Phone: Children (Including the student whose details have been furnished here) Name Age
Gender Male Female Male Female Male Female Additional Adults Living at Home, if any Name Age
Relationship Gender Male Female Male Female Male Female Male Female Total Number of members in
the Family: Details of employees, if any (domestic help fulltime or part-time, drivers, cook etc.) Name
Age PAN/AADHAAR/Voter I.D No: Gender Male Female Male Female Male Female Male Female 3. About
Home Full Residential Address: Is it an owned or rented property? Nature of Property: House Stand
alone Apartment Complex Apartment Facilities available (if within a Complex): No of Rooms Bedrooms
Bathrooms Guest Rooms Any significant landmark (s) beside the residence: Distance from School in
kilometers: 4. Additional Family Information Primary Language Spoken at home: Other languages
Spoken or known: Religious Affiliation: 3 Internet Access: Y N Has any of the family members ever been
convicted of a crime? Y N Is there any investigation or trial pending against any of the family members
for an offence concerning moral turpitude: Y N 5. Reference for the Host Family Sl No: Name Complete
Address Relationship Contact No: 6. Personal Background a. Do you have any dietary Restrictions? Y N If
yes, please explain (e.g. vegetarian, food allergies): Answering yes will not automatically eliminate you
as a candidate; however, it may require special consideration of host family assignments. Questions for
Students

1. Why do you want to apply for the Student Exchange Program?

It would be an enriching experience to be able to see and understand a different culture, first-hand.
Europe, as a whole, has deep rooted traditions and cultures and it would be very interesting to try and
understand it.

2. What do you think is the most important thing about representing your country and your community
abroad? Self-discipline. Not to throw us in bad light.

3. What trips have you made outside your country? Why did you take these trips, with whom and for
how long?

4. What are the most important issues, which you feel your country is facing?

Poverty, corruption,. Globally—global warming, overpopulation. Awareness is the biggest way. Start w/
school.

How do you think you can contribute towards resolving these issues?
5. Have you ever spent any time away from home on your own? If so, where did you go and for how
long?

Always been w/ either family or friends.

6. Do you have/take any responsibilities at home?

Brother takes after me, so my responsibility to teach him all I can.

If so, what are they?

7. How do you think you should go about meeting people and making friends in a new country?

Try to approach w/ topics that could be either of global interest or try and delve into conversations that
both are passionate about. Theres always at least one topic on which we can maje friends, be it a sport,
hobby, blah

8. What is the most difficult or challenging situation that you have faced in your life? How did you
overcome it and what do you feel are your strengths?

9. The customs and food will be very different from home, in a new country. How will you assimilate and
accommodate? 10. What according to you makes a good host family? 11. Do you think that in your
entire span of stay you will turn homesick at times? If so, how will you manage yourself? 12. Give an
example of a personal weakness. How do you think that this will affect you or your exchange? 13. If
someone asked you to do something that you do not think is appropriate, how will you handle the
situation? 14. If your host family represents a different faith, would you attend prayers or other religious
services with them? How do you feel about this? 7 15. Would you make a genuine effort to know about
the French culture, mannerism and basic French language to facilitate yourself in thus Exchange
Program? If so, how do you plan to go about it? 16. Student’s Letter Write a letter in 250 words
introducing yourself to your future host partner and family. You may talk about yourself, your interests
and hobbies, about your family members, your likes and dislikes, your expectations out of this exchange
program and how you wish to contribute as a participant in this program. (Attach a typed copy with this
form) Questions for Parents: 1. How do you feel about your son/daughter going abroad for 12 days? 2.
Your ward has expressed interest in the Exchange program to France. Do you have any immediate
concerns regarding the chosen country? If yes, kindly share the same. 3. Do you think that your
son/daughter will be homesick? If so, how will you deal with it and how can you help him/her cope with
feelings of homesickness? 4. Whose idea was it to apply for the program? Are you entirely committed to
let your son/daughter to go for the Exchange? 5. Does your ward enjoy trying new things and eating a
variety of foods? 6. Does your son/daughter have any medical concerns that we should be aware of? 9
7. What are the 3 most important advices that you will give your child when he/she leaves for France? 8.
How willing are you to host your child’s partner student from France? How do you plan to make him/
her have a comfortable and happy stay in India? 9. How does your child react to disagreement, discipline
and frustrations? 10. What amount of independence do you give your child? 11. What is your child’s
level of maturity in handling relationships? 12. What makes you proud of your child? 13. Are there any
other comments, which you would like to share with us? 11 DECLARATION I solemnly state and affirm
that all of the statements in this Declaration, and in any attachments hereto, are true and correct to the
best of my knowledge. I also certify that I have not withheld any information that would affect this
Declaration unfavorably, if disclosed. I understand that any omission of facts or misrepresentation will
result in my elimination from consideration for Host Family in the Student Exchange program. I further
certify that I understand that the intent of The Newtown School is to deny a position to anyone
convicted of a crime of violence or a crime against another person. I hereby authorize The Newtown
School and its Service Provider to request and receive any and all background information
about/concerning me, including but not limited to my Criminal History, AADHAR Number Trace, Driving
Record, Employment History, Military Background, Civil Listings, Educational Background, Professional
License from any Individual, Corporation, Partnership, Law Enforcement Agency, and other entities
including my Present and Past Employers. This search will NOT access or disclose ANY financial history or
personal information not applicable to the criminal history report. I understand that this information will
be used to determine my eligibility for member of Host Family in the Student Exchange Program. I also
understand that as long as I remain a member of Host Family in the Student Exchange, the criminal
history records check may be repeated as deemed necessary. I waive any right to assert that such an
investigation or request constitutes an invasion of my privacy. I recognize that such inquiries are in the
interest of all persons involved in Student Exchange, and I fully consent to such investigations. I
understand and agree that the Newtown School may, in their sole discretion, decline to accept my
application for Host Family with or without cause. I acknowledge that I have read and understood the
above affidavit, waiver, consent and release, and that I sign this form voluntarily. Name of Host Father
Name of Host Mother Signature Signature Date : Place: Date : Place: Name of Additional Adult Resident
(18 and older) Signature Date : Place: Photos Select a color photograph for each topic below, and match
each photo to this page with glue or double-sided tape (do not staple). Include brief captions, if
necessary. MY FAMILY MY SPECIAL INTEREST Photo that includes members of your immediate family
including yourself Photo of you participating in your favourite hobby or activity 13 SOMETHING
IMPORTANT TO ME MY HOME Photo of your friends, pet, musical instruments ,etc. Photo of your house
or building where you live