Instructions for completing this application: All sections of this five-page application for the




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YES PRELIMINARY APPLICATION FORM 2016 – 2017

Instructions for completing this application: All sections of this five-page application for the

Youth Exchange and Study (YES) Program must be fully completed in order to be considered for

the next step – which is English language testing. Missing or incomplete information will delay the processing of your application.
I. STUDENT INFORMATION:

Please write your name as it appears in your passport.
______________________________________________________________________________

First Name Middle Names Last Name


Do you ever spell your name differently? If so, how: ___________________________________
Please write your nickname(s) or the name(s) that your friends at school or home call you.
______________________________________________________________________________
E-mail: Mobile Number: __________________
Address:
City: Post Office Box:
Country: Home Phone:
Permanent Residence in Qatar: Citizenship Country:
Birth Date (mm/dd/yyyy):
City of Birth:
Country of Birth:
Are you a U.S. Citizen or do you have a U.S. Passport?
Have you ever applied for a green card or a U.S. permanent residency?
II. FAMILY INFORMATION:

Father’s Data:

First Name Last Name

Occupation: Mobile:

Mother’s Data:

First Name Last Name


Occupation: Mobile:
Family Data:
Student lives with:

Parents are:


Family Members:
Name Sex Age Relationship Grade Level

/ / / / _________

Name Sex Age Relationship Grade Level



/ / / /__________

Name Sex Age Relationship Grade Level



/ / /__________/___________


III. EDUCATION:
Name of School:
School Director’s/Principal’s Name:

School Address: ________________________________________________________________

School Phone: __________________________School E-mail: __________________________

What grade level are you currently in?

Number of years of English Study: ___Last Year’s final English grade: ____

Last Year’s overall cumulative grade point average: ____


IV. INTERESTS AND HOBBIES:
List all school activities and all hobbies you have or in which you have participated. Start with

The most recent:



__________________________________ / ________ / ________ /__

Activity Number of Month/Year Month/Year

Hours/Week Started Ended
_______________________________ / ________ / ______________ / ______________

Activity Number of Month/Year Month/Year

Hours/Week Started Ended
_______________________________ / ________ / ______________ / ______________

Activity Number of Month/Year Month/Year

Hours/Week Started Ended
_______________________________ / ________ / ______________ / ______________

Activity Number of Month/Year Month/Year

Hours/Week Started Ended
Have you received any awards, or do you have any outstanding achievements in the activities

listed above?


__________________________ / __________________________________ / __________

Name of Award/Achievement Reason for receiving Award Date received


__________________________ / __________________________________ / __________

Name of Award/Achievement Reason for receiving Award Date received


__________________________ / __________________________________ / __________

Name of Award/Achievement Reason for receiving Award Date received


__________________________ / __________________________________ / __________
Are there any activities you would like to pursue or to learn while an exchange student in the

U.S.?



V. FUTURE PLANS:
Do you intended to continue your education upon completion of secondary school? _____

If yes, where? ___________

What do you intend to study?

What are your future job or career plans?




VI. THREE SHORT ESSAYS:
Please answer all of the following essay questions with at least three sentences. There are no

"right" answers or "wrong" answers for each question but you should provide enough

information to help the YES screening committee understand you better as an individual.
1) What are the pluses or minuses of participating in this program?

2) What will you do to establish a good relationship with your host family or U.S. schoolmates?


3) Describe a situation when you organized an activity for your friends, school class or club.



Why did you organize it? What was the result?

Thank you! We will contact you regarding your eligibility to participate in an English

language exam.


YES Preliminary Application Form


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