High School Students to Japan:
Application to go on this trip

 

NOTE: you must currently be attending high school in the metro Denver area (including Boulder and in between) to be eligible to go on this trip.


This form gathers information about you and builds a web page using that info.

After you click 'Submit', some basic syntax checks are run and if those tests are successful, your web page is displayed (there is some delay, so please have patience).

At the same time, the webmaster and one of the trip leaders will be sent an email telling them to contact you, to finish the process.

The webmaster will integrate your page into the site and the trip leader will talk to you about the process from here on.

If you have any difficulties, please contact me, Steve Comstock, at steve@trainersfriend.com and I will endeavor to fix the problem.

 

* - indicates a required field

 

 Your information 

* Your first name ("given name")
* Your last name ("family name")

  Gender:  Girl Boy         Birthday. Year (yyyy):   Month (mm):   Day (dd):  

* Email address:  
  Cell phone #:     (leave blank if you don't have a cell phone)

* High school:    

* Graduating class:    2018    2019    2020    2021


      For phone numbers or email addresses you do not know, please code 'n/a'.

* Japanese teacher name:       
   * Japanese teacher email:   
   * Japanese teacher phone #

       (If you do not have a Japanese teacher, enter 'none' in all three fields)




* Additional reference 1:   
   * Reference #1 email:    
   * Reference #1 phone:    

* Additional reference 2:   
   * Reference #2 email:    
   * Reference #2 phone:    



  File name for picture:    
  (do not worry if your picture does not fit right: I will adjust it personally when I get it)

 

 Family information 

Parent / guardian 1:     (full name)
Parent / guardian 2:     (full name)

Street Address line 1:  
Street Address line 2:  
City:                    , Colorado
ZIP code:                

Enter up to three phone numbers, in order of preference
* Phone 1:      Mobile   Home   Work
  Phone 2:      Mobile   Home   Work
  Phone 3:      Mobile   Home   Work

 

 Any allergies / medical info we need to know about 


 

 Hobbies, special interests 


 

 School and community activities 


 

 Any outstanding achievements 


 

 Describe your previous travel experience 


 

 How would you rate your Japanese language skills? 

Conversation:   None   Basic   Intermediate   Fluent
Reading:        None   Basic   Intermediate   Advanced
Writing:        None   Basic   Intermediate   Advanced

 

 What do you like about Japan or Japanese culture? 


 

 What do you hope to get from this adventure? 


 

Note: once you press 'Submit', you will not be able to modify your data: only the webmaster can do that. However, you can contact the webmaster to request changes (or removal of your record so that you can submit again).