Personal Information

Last name: *

First name: *

Middle name:

Maiden name:

Email address: *

Date of birth: *

Address: *

State: *

City: *

Zip code: *

Home phone: *

Work phone:

Cell phone: *

Internet access at home: *

Do you have a valid driver license?: *

If Yes, enter your driver license number below:

Please note, we do not share your personal information with any other organizations. We require driver license information to ensure the safety of students you will work with.

Experience

College and location:

Degree:

Study abroad program:

Years attended:

Previous Experience :

Current employer:

Years there:

Employed:

If currently employed, indicate work schedule:

Please indicate your comfort level with the following items. Rate them 1-5; 1 being the most comfortable

Cold-calling: *

Making presentations: *

Speaking to strangers: *

Performing internet research: *

Language spoken other than English

Language: *

Skill level: *

Have you had a previous affiliation in any way with the Secondary School Student program and/or international exchange students (i.e., hosting, placing, or monitoring exchange students)? If yes, please indicate the name of the sponsor that you were affiliated with, and list the dates of your affiliation with that organization: *

Have you had any contact with any child protective services agency in the past? If yes, please indicate when and for what reason(s).: *

Statement

Please write a paragraph about why you are interested in promoting student exchange with Terra Lingua USA: *

Please indicate any networking abilities you have to support host family recruiting. ie: church, school, civic organizations: *

How did you find us?: *

Is there any specific ad you are responding to?: *

References

We require each of the application to provide us three non-familial references. by completing the information below, a link will be sent to them to complete. Please ask them to watch for this email (check spam) and respond at their earliest convenience.

Reference 1

First name: *

Last name: *

Email: *

Reference 2

First name: *

Last name: *

Email: *

Reference 3

First name: *

Last name: *

Email: *

* Indicates Response Required