J-1 Exchange Organization Application

FOREIGN EXCHANGE PROGRAM

Foreign Exchange Organization Application

ORGANIZATION INFORMATION

Application Type

NEW ORGANIZATION: We have never placed foreign exchange students in the District in the past.RETURNING ORGANIZATION: We have placed students in the District in the past, but not within the past calendar year.

Organization Name*

Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number #1

Area CodePhone Number

Phone Type*

OfficeCellFax

Phone Number #2

Area CodePhone Number

Phone Type

OfficeCellFax

Phone Number #3

Area CodePhone Number

Phone Type

OfficeCellFax

Please supply the name, title, and e-mail address of the main contact for this organization. This could be the national placement director, organization president, etc.

Contact Name*

Title*

Organization E-mail Address*

Is this organization listed as a J-1 Inbound Program with the Council on Standards for International Educational Travel (CSIET)?*

YesNo

What is this organizations' listing status with CSIET?*

FullProvisionalConditional

The Clark County School District will only accept applications from organizations that are listed with the Council on Standards for International Educational Travel.

LOCAL REPRESENTATIVE INFORMATION

Please list the names of each local representative who will be enrolling students in the District.*

Nationally, what is this organization's student to local representative ratio?*

What is this organization's RECOMMENDED maximum number of students per local representative?*

Local Representative Compensation*

PaidUnpaidReimbursed only for expenses

Briefly explain how local representatives are paid, and how much.*

Please include information regarding who will be supervising the above-named local representatives.

Supervisor's Name*

First NameMiddle NameLast NameSuffix

Supervisor's Title*

Supervisor's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number #1*

Area CodePhone Number

Phone Type*

HomeCellOther

Phone Number #2

Area CodePhone Number

Phone Type

HomeCellOther

Phone Number #3

Area CodePhone Number

Phone Type

HomeCellOther

Supervisor's E-mail Address*

STUDENT SUPPORT SERVICES

Please explain this organization's 24-hour emergency contact service.*

Does this organization offer professional counseling services for students having difficulties?*

YesNo

Who pays for the counseling?*

Who determines when the counseling is necessary?*

If the student must return home due to an emergency, who pays those expenses?*

The organizationThe student and/or natural parents

HOST FAMILY AND EXCHANGE STUDENT SELECTION PROCESS

Select the types of placements that this organization allows. (Select as many as apply.)

Single Host ParentDouble Exchange Student PlacementSpring Entry Half-Year students (Students enroll in January and return home in June.)Spring Entry Full-Year students (Students enroll in January and return home the next January.)Arrival/Temporary Host Family Placement

Explain the host family selection and approval process for this organization.*

Explain the exchange student selection and approval process for this organization.*

Which standardized English language proficiency test(s) does this organization use to evaluate students?*

What is the minimum score that students must earn to be accepted?*

LOCAL REPRESENTATIVE SELECTION PROCESS

Explain the local representative selection and approval process for this organization.*

Explain the local representative training process for this organization. (How are representatives trained, by whom, how often, etc.)*

STUDENT AND HOST FAMILY ORIENTATION

Explain the student and host parent orientation process for this organization.*

REQUIRED DOCUMENTATION

Please submit copies of the following forms regarding this organization: 1) Sample Student Application, 2) Sample English Proficiency Test Score Report, 3) Host Family Application Forms, 4) Area Representative Reporting Forms, 5) School Acceptance Form, and 6) CSIET Certificate of Acceptance (for the upcoming school year)

Attach the documents you will be submitting below. It is best if they are in PDF format, but you may also submit documents in other formats. *NOTE: The system will allow you to upload multiple documents.*

Select File

This application was completed by:*

E-mail Address*

Confirmation Email

After submitting this application, an e-mail receipt will be sent to the e-mail address entered above. Please allow up to four business days for this application to be approved once all materials have been received.