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Name of High School:

Address:

City:

State/Province:

Zip/Postal Code:

Name of teacher/counselor ( if any ) who told you about ASSE:

What are your favourite high school subjects?

Are you active in sports?

Which sports?

Which (if any) foreign countries have you visited?

What are your favourite hobbies, interests, etc.?

In a few words, why do you wish to become an ASSE Exchange Student?

How did you first learn about the ASSE Exchange Program?

Can you obtain letters of reference from teachers who know you, your high school principal,

and people in your community?

Yes

No

What do you feel you would gain by becoming an exchange student abroad?

Please attest to the factual accuracy of the above information by signing below:

Applicant Signature

Date

Signature of Father/Legal Guardian

Date

Signature of Mother/Legal Guardian

Date

Financial Scholarships

(School Year Program Only): A limited number of scholarships are available to students demonstrating academic

excellence and financial need. If you are interested in applying for a scholarship, please check the following box:

TEAR HERE

FEE SCHEDULE ( US $ )

Preliminary Application and Fee:

As soon as possible

Final Application Packet and Program Fee Deposit:

$700

Summer

$1200

School Year and Semester

Submitted Prior to:

March 01

School Year and Semester Programs

to Thailand

( July departure )

April 01*

School Year and Semester Programs

departing in August or September

Summer Homestay Programs

May 15

Summer Language Programs

Sept. 01*

School Year and Semester Programs

departing in January, March or May

Final Payment of Program Fees: †

Submitted prior to:

May 01

School Year and Semester Programs

to Thailand

( July departure )

June 01

School Year and Semester Programs

departing in August or September

Summer Homestay/Tour Programs

Summer Language Programs

Nov. 01

School Year and Semester Programs

departing in January

Dec. 10

School Year and Semester Programs

departing in March or May

Refund Policy

– Preliminary application fee refundable if applicant is not

accepted by ASSE.

– Program fee deposit refundable if applicant is not

accepted by ASSE or not granted ASSE scholarship.

– Program fee deposit less $500, any airline fees and host

country cancellation fees, refundable if ASSE receives

cancellation in writing at least 90 days prior to departure.

– Program fees less deposit, airline fees and host country

cancellation fees refundable if ASSE receives written

cancellation within 60 days of departure date.

– No refunds subsequent to departure for school year and

summer programs.

– $350 penalty, plus any airline imposed penalties/fees, for

any exchange student not returning home on the interconti-

nental flight with his/her group.

10% reduction in Program Fees (excluding Preliminary

Application Fee) for earlier school year program application.

Please see page 21 for details.

*Scholarship Applications due by March 01.

(School Year Program Only)

Final Program Fee payment by cashier’s cheque, money

order or credit card (Visa, MasterCard, Discover or American

Express).