Initial Application - 2021 ABOUT YOU! Question Title * 1. Personal Details First Name Last Name Gender Street Address City/Town State/Territory Post Code Country Email Address Phone Number Question Title * 2. Date of Birth Date of Birth Date Question Title * 3. Your Home Country Australia New Zealand Other (please specify) Question Title * 4. I live with my Mother(s) Father(s) Step-Parent Other Guardian(s) Question Title * 5. Parent or Guardian 1: First Name * Last Name * Relationship to Student Email Address * Phone Number * Question Title * 6. Parent or Guardian 2: First Name Last Name Relationship to Student Email Address Phone Number IMPORTANT:When dealing with minors (under 18 years of age) all email correspondence between YFU and students is also sent to parents/guardians using the email addresses provided on this form. If you have special circumstances that may impact our right to communicate with you as a group please email us at info@yfu.com.au at time of submitting your initial application so we are aware of your situation before we send any email correspondence. EDUCATION Question Title * 7. Current School Information School Name City/Town State/Territory Current School Year Question Title * 8. Foreign Language Studies Language Years studied Language 1 (if applicable) French German Spanish Japanese Korean Italian Chinese Other Language 1 (if applicable) Language menu 1 2 3 4 5 5+ Language 1 (if applicable) Years studied menu Language 2 (if applicable) French German Spanish Japanese Korean Italian Chinese Other Language 2 (if applicable) Language menu 1 2 3 4 5 5+ Language 2 (if applicable) Years studied menu Language 3 (if applicable) French German Spanish Japanese Korean Italian Chinese Other Language 3 (if applicable) Language menu 1 2 3 4 5 5+ Language 3 (if applicable) Years studied menu Question Title * 9. General school grades current School Year previous School Year Average school grade for A B C D E F Average school grade for current School Year menu A B C D E F Average school grade for previous School Year menu HEALTH & WELL-BEING If you tick yes to any of the below questions one of our Program Managers will contact you to chat in person. Question Title * 10. Dietary - Do you have any of the following dietary requirements? Vegetarian Vegan Pescatarian Gluten Free Lactose Free Other Dietary Requirements No Dietary Requirements Question Title * 11. Medical - Do you have any of the following medical conditions? Condition that restricts physical activity Prolonged illness either recently or in the past Anxiety Depression Diabetes Epilepsy Other Medical Condition No Medical Conditions Question Title * 12. Medication - Are you currently taking any prescription medications? Yes and I will need to continue while on exchange Yes but I will not need to continue while on exchange No I am not taking any prescription medications currently Question Title * 13. Counselling/Therapy - Have you participated in counselling/therapy in the past two years Yes No Question Title * 14. Allergies - Do you have any of the following allergies? Allergy to any animals Allergy to any plants Allergy to any foods Other Allergy No Allergies YOUR EXCHANGE PREFERENCES Question Title * 15. Desired length of program (select all that apply) Year (10-12 months) Semester (4-6 months) Trimester (3 months) Short Program (2 months) Question Title * 16. Desired departure timeframe (please note all departures are not available for all programs) January 2021 August 2021 November/December 2021 January 2022 August 2022 Other (please specify) Question Title * 17. First country of preference Argentina Austria Belgium Brazil Canada Chile China Czech Republic Denmark Estonia Finland France Germany Italy Japan Latvia Lithuania New Zealand/Australia Netherlands Norway South Korea Spain Sweden Switzerland Uruguay USA Question Title * 18. Second country of preference Argentina Austria Belgium Brazil Canada Chile China Czech Republic Denmark Estonia Finland France Germany Italy Japan Latvia Lithuania New Zealand/Australia Netherlands Norway South Korea Spain Sweden Switzerland Uruguay USA Question Title * 19. Third country of preference Argentina Austria Belgium Brazil Canada Chile China Czech Republic Denmark Estonia Finland France Germany Italy Japan Latvia Lithuania New Zealand/Australia Netherlands Norway South Korea Spain Sweden Switzerland Uruguay USA Question Title * 20. Where did you hear about YFU? YFU Volunteer / Returnee Teacher/School Official Newsletter/Brochure Google (by Googling Student Exchange or something similar) Social Media Friend or Family Other (please specify) DECLARATION Question Title * 21. I confirm that all the information given in this application is accurate Yes Question Title * 22. I confirm that my parent(s)/guardian(s) know of and agree to my applying for exchange Yes Question Title * 23. Payment of your $100 Initial Application fee can be made by direct deposit. IF YOU LIVE IN AUSTRALIA:Account Name YFU Australia LtdBSB 067-000Account Number 10972978IF YOU LIVE IN NEW ZEALAND:Account Name YFU Australia New ZealandAccount Number 12-3488-0010416-00Please include your full name so we can identify your payment and email a screenshot of your payment to info@yfu.com.au or info@yfu.co.nz Yes I have paid the $100 Application Fee by direct deposit No I have not yet paid the $100 Application Fee by direct deposit SUBMIT
