Homestay - Agape English Language Institute for Internationals, USA

寄宿家庭申請單

假如你在AGAPE語言學校上學期間想要和美國人的家庭住在一起,請完成以下這個線上的申請單,請在你來美國前寄至AGAPE語言學校來.並附上美金一百元做為寄宿家庭的申請費(可用bank draft, money order, 或 wire transfe)請寄到以下住址:

Agape English Language Institute
Post Office Box 12504
Columbia, South Carolina 29211-2504
USA

1. Location of program(就讀地點)
This homestay application is for Agape English Language Institute's program at: (這個寄宿家庭申請表是針對在AGAPE語言學校就讀的學生) (Please choose one)	Columbia Greenville (Cost:$600 per 4 weeks; $900 per 8 weeks; $1000 per 9 weeks)
2. Personal Information (個人資料)
Family Name (姓氏):
Given Name (名字):
Other Name:
Address (住址) (Line 1):
Address (Line 2):
City (城市):
State/Province (州/省份):
Country (國家):
Zip/Postal Code (郵遞區號):
Phone (電話):
Fax Number (傳真號碼):
E-mail (Required):
Date of Birth (生日):	mm/dd/yy
Country of Birth (出生國家):
Country of Citizenship (哪一國公民權):
3. Emergency Contact (緊急聯絡人) Person to contact in case of an emergency.
Name (姓名):
Address (地址)(Line 1):
Address (Line 2):
City (城市):
State/Province (州/省份):
Zip/Postal Code(郵遞區號)
Business Phone (辦公室電話):
Home Number (家裡電話):
Relationship to You (和你的關係):