Enrollment

Application for Admission: Full Semester & Summer Internship +

Step 1 of 4

Program for which you are enrolling *

PARTICIPANT INFORMATION

Full Legal Name (as it appears on your passport or driver's license) *

First

Middle

Last

Nickname/Preferred First Name

if different than legal name

Date of Birth *

Sex *

on your passport

Preferred Gender *

How did you hear about our program? *

Permanent Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Primary Phone *

Alternate Phone

Primary Email Address *

Alternate Email Address

Citizenship *

Citizenship 2

only if dual citizen

City and State of Birth *

Country of Birth *

Do you currently have a valid passport? *

If no, please begin your passport application as soon as possible. Passports must be valid for 6 months after departure from Italy.

EMERGENCY CONTACT INFORMATION

Name *

Relationship *

Same as Permanent Address

Same as Permanent Address

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Primary Phone *

Alternate Phone

Primary Email Address *

Name of Secondary Emergency Contact *

Relationship *

Primary Phone *

Alternate Phone

Primary Email Address *

HOUSING INFORMATION & PREFERENCES

Please respond honestly to the following questions, as your answers will help us to place you in the homestay best suited to your preferences. Please note that we cannot guarantee fulfillment of all requests, and that your answers to these questions have no bearing on your admittance into the program.

Give us a brief description of your family and describe the relationships you have with each member of your family? *

Describe your present living situation (at home and/or college/university). *

What parts of your daily/weekly routine are most special or important to you? *

What excites you most about coming to Italy? What worries you most about coming to Italy? *

What are your expectations for your Italian host family? *

Do you prefer a private or shared room? *

When do you normally go to bed? *

What is your tidiness level? *

Do you smoke? *

If yes, you should plan to do so outside.

Do you have any dietary needs or restrictions? *

Would you consider yourself an introvert or extrovert? *

Are you comfortable having children around? *

Are you comfortable having pets around? *

Do you have any allergies? *

Do you like to exercise/play sports? *

What type of music do you like? *

Do you play an instrument? *

What is your favorite film and/or book and why? *

Is there anything regarding your sexuality and/or gender that you think we should know in order to choose the most accepting host family for you? Please indicate whether you feel comfortable sharing this information with your host family or if you would like it to be private.

Do you have any differing abilities or special accommodation requests we should be aware of in order to choose the most appropriate host family for you?

Are you hoping to participate in the Molise Italian Studies program with a friend, roommate, partner, or spouse?

5897445504

Enrollment

Application for Admission: Full Semester & Summer Internship +

PARTICIPANT INFORMATION

EMERGENCY CONTACT INFORMATION

COLLEGE/EDUCATION INFORMATION

HOUSING INFORMATION & PREFERENCES

PERSONAL STATEMENT