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* 1. What is your name?

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* 2. For 2020, what CISV programs are you interested in for Child #1?

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* 3. For 2020, what CISV programs are you interested in for Child #2?

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* 4. For 2020, what CISV programs are you interested in for Child #3?

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* 5. Are there any countries that you or your child would especially like for a CISV program?

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* 6. Please check any country where you would NOT send your child?

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* 7. If your child will be 11 in 2020, would you prefer your child attend a program hosted in the United States or Canada?

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* 8. If you are interested in Step Up, rank your preferred region for the programs

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* 9. For youth age 12 or 13, would you prefer an 8 day program in Mongolia or Japan or 15 day program in Canada or USA?

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* 10. For a winter program would you prefer a 2 week program where your child would miss school or 8 days that minimizes the amount of school missed? More educational content is delivered in a 15 day program.

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* 11. What is the name, age and gender of Child #1?

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* 12. What is the name, age and gender of Child #2?

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* 13. What is the name, age and gender of Child #3?

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* 14. Would you be willing for your child to miss school to attend a CISV program?

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* 15. What is your cell phone number?

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* 16. What is your email address?

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