First Name: *

MI:

Last Name: *

Birthdate (MM/DD/YYYY): *

Gender: *
Please select... Female Male

Name as you'd like it to appear on your badge: *

Where did you first hear of WAS? *
Please select... High School Past Participant Next Step WHSMUN Rotary Lions Optimist Kiwanis Other

Address: *

City: *

State/Province: *

Country: *

ZIP/Postal Code: *

Email: *

Home Phone: *

Name: *

Email: *

Daytime Phone Number: *

High School Name: *

Sponsoring High School Official
(Guidance Counselor, Teacher or Principal who will be endorsing your application.

HIgh School Address: *

High School City: *

High School State/Province: *

High School Country:*

High School ZIP/Postal Code: *

Grade Point Average: *

Year in High School (as of May 2009)
Please select... Sophomore-10 Junior-11 Senior-12

Full Name of Sponsoring Service Club or Organization:

Home Country / Passport Issued by:

Date Departing from the US (MM/DD/YYYY)

Name of Exchange Program: