|
|
If you prefer, you may print this form out and fax it to us at (302) 831-3348.
What is your passport number?
By what country (or authority) is your passport issued?
What is your passport expiration date (month/day/year)?
|
|
|
Have you ever been issued a Social Security Number or a Tax Payer Identification number by the United States Government? These numbers are in the format 123-45-6789.
What is your e-mail address?
What is your complete mailing address at school?
What is your telephone number at school?
What is your complete home mailing address?
What is your home telephone number?
What is your mobile telephone number?
What is your fax number?
Do you have any medical conditions which limit your ability to walk?
Do you have any other medical conditions which we should know about or are you on any prescription medications?
Do you smoke?
Do you eat beef?
|
Do you eat pork?
|
Do you require that meat you eat be butchered in a religious/ritualistic manner?
|
Do you eat fish?
|
Do you eat shell-fish?
Do you eat only vegetarian?
|
If you eat only vegetarian, do you eat eggs?
|
If you eat only vegetarian, do you eat/drink dairy products?
|
If 21 years old or over, do you drink alcohol?
|
Although you will be provided access to the University's dining hall as well as a cash allowance which you might spend at local restaurants, would you also like the ability to prepare your own meals in your residence?
|
Do you have any other dietary restrictions? If so, please describe?
Please list any places where you have lived or traveled outside your country:
What are your current academic, intellectual, and research interests?
In addition to activities organized by the Institute, what are you most interested in seeing/doing during your visits to New York and Washington DC?
What are your hobbies and interests?
What are your favorite movies about Americans and the United States?
Name the one book, either non-fiction or fiction, which you believe would be the most useful for a person from your country wanting to learn about the United States (but who has never read anything about the United States) to read.
List the three most recent books of American Literature which you have read. Did you like or dislike them? Why?
How comfortable are you with listening to English?
How comfortable are you with speaking English?
How comfortable are you with reading English?
How comfortable are you with writing in English?
What would you most like to learn about the United States and its people?
What is/are your greatest concern(s) about the Institute or visiting the United States?
Are there any special ways in which we can help make you feel more comfortable during your stay?
Has your visa been issued?
|
Is there anything else we need to know?
-or-
After submitting the form, press your browser's back button to return to this page.
|
|
|
|
|
|