Personal Information

Name (First/Last):   

Home Address:  

City:   

Postal Code:  

Country:  

Home Phone (include country and city codes):  

Business Phone:  

*E-mail Address:  

Are you representing yourself or an organization?   Self Organization

(if not a business, please disregard the next section.

Organization Represented

Organization name:  

Business address:  

City:  

Postal Code:  

Country:  

Business phone (include country and city codes):  

Business FAX (include country and city codes):  

Web Site:  

Type of organization (check all that apply):  
(hold down the ctrl button to select multiple values Student exchange program Language school Travel agency Academic institution Other

If other:

Types of programs offered (check all that apply)
(hold down the ctrl button select multiple values Academic homestays abroad Domestic homestays for foreign students Language courses Tours Other

If other, please describe:  

Is your organization organized as a non-profit agency?   Yes No

Number of years in business:   0-5 6-10 11 or more

Current or most recent U.S. partner (leave blank if none):  

Reason for interest in changing partners:  

Is your program able to place American high school students in host families?   Yes No

Recognizing that S.A.I. offers only semester and year academic homestay programs for high school students between the ages of 15-18 years, would you like a package of informational materials sent to you? Yes No

If yes, would you prefer the materials to be sent to your home or business address? Home Business

Type the code below. Please no spaces.

HS1SRD1B