Oregon International School

Student Information Section
Student Name *

Family (Last) Name Middle Name Given (First) Name
Preferred Name
Student Gender *
Date of Birth *

Month Day Year
Date
Address of Residence *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Country of Citizenship (if different from residence address)
Please list country and province
Country of Birth (if different from residence and citizenship)
Please list country and province
Religious Affiliation *
Housing Preference
*This is not a guarantee student will be placed in preferred, but gives us information for development of program
Email *
example@example.com
Skype Username (student)
(optional) If one is used
Mobile Phone Number *

Country Code Area Code Phone Number
Please upload a scanned copy of student's birth certificate: *

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Please upload copy of passport *

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Please Upload current photo of student *

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Family Information Section
Father Name *

Family (Last) Name Middle Name Given (First) Name
Occupation *
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email *
example@example.com
Skype Username
(optional)
Mobile Phone Number *

Country Code Area Code Phone Number
Home Phone Number (If different from mobile)

Country Code Area Code Phone Number
Mother Name *

Family (Last) Name Middle Name Given (First) Name
Home Address (if different) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Occupation *
Email *
example@example.com
Skype Username
(optional)
Mobile Phone Number *

Country Code Area Code Phone Number
Home Phone Number (if different)

Country Code Area Code Phone Number

Health and Fitness Section
Please list any allergies we should be aware of: *
Please list any pre-existing conditions or health concerns we should be aware of: *
Please list any physical activities student should refrain from or avoid: *
Please list any other physical health concerns we should be aware of: *
Is Student Covered by Major Medical Insurance?

Yes No Unsure
Note: Major medical insurance is required for participation. If the student is uninsured, please contact us about exploring coverage options through local providers. You can Contact us at BakerCulturalExchange@bakersd.org or by calling 1-888-366-4492
If you indicated "Yes" student does have medical insurance, please upload a copy of proof of insurance card:

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Student Education Background Section
Name of High School *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Grade Point Average (GPA) *
Current Grade Level of Student
Desired Grade Level for Student While in America
Courses taken to this current academic year: *
Please list out course work and year taken
How many years have you studied English? *
Please list total years you have taken English coursework
How would you characterize your English reading ability? Beginning, Moderate, or Advanced? *
How would you characterize your English writing ability? Beginning, Moderate, or Advanced? *
How would you characterize your English speaking ability? Beginning, Moderate, or Advanced? *
Please upload a copy of high school transcripts: *

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Sports and Extracurricular Activities Section
Please list any extracurricular activities you enjoy and have participated in: *
Please list activities and years participated
Please list any sports you enjoy and have participated in: *
Please list activities and years participated
Are there any sports of clubs you are interested in joining once here? *
Please list any activities you have an interest in learning/joining in once here

Music/Fine Arts, Hobbies and Personal Interests Section
Please list any musical instruments you play: *
Please describe any other interests you have in the arts: *
Please list any hobbies or other interests you enjoy: *
IE: Fishing, Hiking, Skiing, Skateboarding, Woodworking, Reading, Etc.

Writing Prompt Section
In the field below, please write a two to three paragraph response explaining a) who you are, b) what your future plans are and why, and c) why you wish to study in America: *