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My Information

Family Name*
Given Name(s)*
Home Address (Street)
City*
State*
Zip
Home Phone*
Cell Phone
*Required fields
Spouse's Name (If any)
Children's Names (If any)
Age
Sex
Live at Home?




Name of Nearest Public High School
ASSE Area Representative (if any)

Desired Student Profile

NationalityFirst ChoiceNationality (First Choice)
Second ChoiceNationality (Second Choice)
Third ChoiceNationality (Third Choice)
Gender
Age
Interests

Please feel free to add interests or expand on any of the preferences listed (If sports, which sports? If music, which kind of music? etc.)

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