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1. First Name, exactly as it appears on passport. Please type in ALL CAPS. If you do not have a passport yet, please enter your name exactly as you will/have entered it on the passport application.

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2. Middle Name or Initial, exactly as it appears on passport (or blank if none on passport. Again, ALL CAPS.

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3. Last Name, exactly as on passport. Again, ALL CAPS.

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4. Passport Number

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5. Date of Issue of Passport

Date

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6. Expiration Date of Passport

Date

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7. Place of Birth (as listed on passport)

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8. Place where passport was issued (most U.S. passports say "United States Department of State"

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9. Date of Birth

Date

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10. Nationality (as listed on passport)

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11. Other credential information (for those who do not have a US Passport, enter your greencard or other information here)

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12. Home Address: Street

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13. City

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14. State

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15. Zip Code

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16. E-mail

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17. Emergency Contact Name

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18. Emergency Contact Relationship

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19. Emergency Contact Phone Number

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20. Emergency Contact E-mail

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21. Select the pet animal allergies you have (for home-stay purposes)

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22. Do you have asthma or any problems with smoke (for home-stay and hotel purposes)

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23. Food allergy or restrictions. Select the food(s) you cannot eat.

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24. Food allergy comments. Please comment below if any of your answers above require explanation

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25. Other allergies (pollen, penicillin, etc.). You will also be filling out a more complete medical fact sheet later, but we need general allergy information at this point.

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