Student Registration – Global Bridge Associates

Student Registration 2023-2024
APPLICATION INSTRUCTIONS
- Carefully complete this application form.
- The host family will receive a copy of the original application.
- Please attach at least two recent pictures of the Student.
- Incomplete applications will not be processed.
Student Information
Student Legal Name*

First NameMiddle Name (optional)Last Name
Preferred Name*
Student Grade*
Student Nationality *
Student Gender*

MaleFemale
Student Date of Birth*

MonthDayYear
Date
Student Wechat or other Messenger ID*
Please state what messaging app you are using and the ID
Student email*
Student Cell Phone*
Student Home Phone*
Student Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Fees and Payment Information
Are you new to Global Bridge Associates or re-enrolling?*

NewRe-Enrolling
Age Level*

Grade (1-5)Grade (6 -12)University LevelGraduate School
Airport Pick Up (Optional)

$250 (Per Trip As Needed)
Father/Guardian Information
Father/Guardian Name*

First NameMiddle Name (optional)Last Name
Father/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Father/Guardian Phone*
Father/Guardian Email*
Father/Guardian Wechat or other Messenger ID*
Please state what messaging app you are using and the ID
Father/Guardian Occupation*
Emergency Contact
Emergency Contact Name*

First NameMiddle Name (optional)Last Name
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact Gender*

MaleFemale
Emergency Contact Phone*
Emergency Contact Email*
Emergency Contact Relationship to Student*
Mother/Guardian Information
Mother/Guardian Name*

First NameMiddle Name (optional)Last Name
Mother/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mother/Guardian Phone*
Mother/Guardian Email*
Mother/Guardian Wechat or other Messenger ID*
Please state what messaging app you are using and the ID
Mother/Guardian Occupation*
Student Medical Information

Health insurance is provided for all International students. In order for the School to properly care for the Student, it is extremely important for Global Bridge Associates to have as much information as possible regarding the Student’s medical history. Please be thorough when answering the following questions. This information will be shared with the Global Bridge Associates Homestay staff and host family only.
Does the Student have any allergies (food, animals, medicine, other)?*

YesNo
Does the Student have any pre-existing medical conditions or any medical concerns FPS should be aware of?*

YesNo
Is the Student in good health?*

YesNo
Does the Student have any dietary restrictions or requirements?*

YesNo
Will the Student be taking any over-the-counter medications?*

YesNo
Does the Student require any prescription medications?*

YesNo
All medications that must be administered at school must come with a completed “Medication Administration Consent” form.
Student Personal Information
Does the Student require any prescription medications?*

YesNo
How many years has the student studied English?*
Other Languages Spoken
Religious Preference
Student's English Ability*

ExcellentGoodFairPoor
Would the student attend church services with the host family if the services were different from the Student’s own religion?*

ExcellentGoodFair
Would the student attend church services with the host family if the services were different from the Student’s own religion?*

YesNo
Would the student attend church services with the host family if the services were different from the Student’s own religion?*

ExcellentGoodFair
Is the Student comfortable living with young children (0-4) in the house?*

YesNo

Please have the Student rank the following statements by checking the number (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree).*

	1	2	3	4
I use the home computer all the time.
I enjoy watching and/or participating in sports.
I enjoy outdoor activities.
At mealtime, I enjoy eating new/different foods.
I enjoy spending time with family and/or friends.

Is the Student comfortable living with young children (0-4) in the house?*

YesNo
Is the Student comfortable living with young children (0-4) in the house?*

YesNo
Does the Student have a US driver’s license valid in the State of California?*

YesNo
Does the Student’s family have a car that the Student will have access to while residing in the homestay?*

YesNo
Does the Student smoke cigarettes in their home country?*

YesNo
Does the Student play a musical instrument?*

YesNo
Does the Student play on any sport teams?*

YesNo
Can the student swim?*

YesNo
Please list any other specific interests, hobbies, and activities and any awards or commendations.*
Describe your family and the Student’s life in your home country.*
Has the Student traveled to the USA before? If so, when and for how long? Has the Student traveled to other countries?*
What does the Student consider their greatest personal strength?*
What clubs/organizations has the Student been involved in at school or in their community?*
Why has the Student chosen to live in a homestay?*
What does the Student like to do in their free time?*
Check any of the following that describes the Student.*

OutgoingQuietShyComicalSeriousArtisticTalkativeAthleticOther
Student Photographs

Please provide two photographs of the Student.
Student Photograph 1*

Cancelof
Student Photograph 1 Description*
Student Photograph 2*

Cancelof
Student Photograph 2 Description*
Student Personal Statement
Please have the Student tell us a little bit about themselves so that GBA can find a host family who is the best match for the Student.
Time*

Hour Minutes

AM/PM Option
Should be Empty:

Student Registration 2023-2024

Student Information

Fees and Payment Information

Father/Guardian Information

Emergency Contact

Mother/Guardian Information

Student Medical Information

Student Personal Information

Student Photographs

Student Personal Statement