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Student Application
Christmas International House, Harrisburg, Pennsylvania
Market Square Presbyterian Church
20 South S. Street
Harrisburg, PA 17101
If you would prefer to print the form and mail it to us,
click here
.
Family Name
*
E-mail Address:
*
Name you like to be called
Male/Female
*
Male
Female
Home Country
*
Age
*
Birthday
*
U.S. Mailing Address
*
City
*
State
*
Zip
*
Phone
College or University
*
Major
U.S. emergency contact name
U.S. emergency phone number
Favorite American foods
List allergies and/or dietary restrictions
Hobbies and interests
Religion
Language(s)
Brothers
Sisters
Pets
Do you have any family members or relatives in the U.S.?
Yes
No
Why do you want to join this program?
Please list any special interests, requests or comments
*
Required
