Personal Information

Application for membership in Lafayette Sister City Student Exchange Program is open to Greater Lafayette youth who complete this application, reside in the region and are incoming or current high school students, along with recent graduates. We are seeking students that would like to experience Ota City, Japan. The date for the exchange is July 8th-18th.
 
The Greater Lafayette Sister City Student Exchange Program selection committee will select members of the exchange program. Selection will not be made on the basis of academic, leadership or organizational skills and achievements, but rather on the youth’s:
 
  • Interest in Japan
  • Creativeness of application response
  • Commitment to attend the two mandatory pre-trip meetings
 
To apply:
1. Complete this application (please print) and sign.
2. Obtain your parent’s or legal guardian’s signature, giving you permission to participate.
3. Mail or deliver the application with a printed photograph of yourself, so it’s received by March 1st, 2019:
 
Greater Lafayette Commerce
Attn: Trent Fletcher
337 Columbia Street Lafayette, IN 47901
tfletcher@greaterlafayettecommerce.com; 765-742-4044
 
4. Valid U.S. Passport information mustbe provided no later than May 1st to be eligible. (Please keep in mind how long it takes to obtain a passport)

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* 1. Student Information

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* 2. Gender:

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* 3. Text Messaging Yes or No?

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* 4. Parent Information

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* 5. Text Messaging Yes or No?

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* 6. Do you have any dietary restrictions and/ or allergies?

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* 7. Are you allergic to any medications?

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* 8. Do you have Medical Insurance?

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* 9. If you do have Medical Insurance does it cover international travel?

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* 10. Do you have a history of criminal activity?

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