AMIE Student Application Form(v1.

0)

Application Process
If you meet our eligibility requirements, you’re ready to begin our application
process. Here’s how to enroll in a summer program:

• Complete and submit the AMIE Student Application Form

• Write and submit a 700-word essay about the importance and benefits of
cultural awareness and understanding
• Ask your teacher and/or a school official to complete the School Certification
and Teacher Recommendation sections of this form
• Ask your parent/guardian to
- Complete and sign the Parent/Guardian Agreement section of this form
- Complete and submit the Host Family Application if this program will
be in your country of residence
• Interview with AMIE's acceptance committee
• Be selected by AMIE's selection committee
• Pay a subsidized camp fee or apply for a full Scholarship

Student Information
First name
Last name
Address
City/State/Zip
Country
Telephone
Email address
Date of birth (mm/dd/yyyy)
Country of birth
Country of citizenship

Family Information
Parent/guardian name (living with
you)
Relationship to you
Daytime telephone
Email address
2nd parent/guardian name (if
applicable)
Relationship to you
Address (if different from above)
City/State/Zip
Country
Daytime telephone
Email address

-1-
Emergency Contact
Contact name
Relationship to you
Daytime telephone
Alternate telephone
Email address
Alternate contact name
Relationship to you
Daytime telephone
Alternate telephone
Email address

Tell Us About You

Name of your school
Current grade level
Grade point average
My favorite school subject is…
Languages I speak
I belong to these groups (clubs,
organizations, etc.)
My favorite activity is…
My second-most favorite activity is…
Have you participated in an exchange
program before? (If yes, please
specify)
The main reason I want to participate
in an AMIE summer exchange program
is…
Do you have a medical/physical
condition that restricts your activities?
(If yes, please specify)
Do you have a medical/physical
condition that requires
medication/special treatment? (If yes,
please specify)
If you take medication, do you need
supervision when taking it?
I am allergic to…
Do you have any special dietary needs
(If yes, please specify)
Would you be able to live with a host
family that allows pets to be inside the
home? (If no, please list any
restrictions)

My Activities and Interests

I like to spend time with my friends:

□ a lot □ quite a bit □ not much □ hardly ever □ never

-2-
I like to spend time on my own:
□ a lot □ quite a bit □ not much □ hardly ever □ never

I like to read: □ a lot □ quite a bit □ not much □ hardly ever □ never

I like to watch TV: □ a lot □ quite a bit □ not much □ hardly ever □ never

I like to be busy: □ all the time □ most of the time □ some of the time

I like to be physically active: □ all the time □ most of the time □ some of the time

I like to be outside: □ all the time □ most of the time □ some of the time

I enjoy team sports □ yes □ no

My favorite team sport

I enjoy individual sports □ yes □ no

My favorite individual sport

School Certification (to be completed by a school official)

I certify that the school information listed above is accurate (including current grade
level and GPA).
School Official’s name
Title
Telephone
Email address
School name
City/State/Zip
Country

Signature of School Official________________________________________

Date__________________________________________________________

If you would like to know more about the American Moroccan International
Exchange, please indicate below:
I would like more information about AMIE.
I would like a presentation at our school.

Teacher Recommendation (to be completed by a teacher or other

school official)

Please complete the information below; if you prefer to submit a confidential

evaluation, you can email or mail this information directly to AMIE.

How long have you known this student?

Describe the talents, interests and/or
skills you have seen this student
demonstrate, and how these attributes
will contribute to a successful exchange
program
Describe one strength

-3-
Describe one opportunity for growth and
how you think an exchange program
could help
Is there anything else you would like us
to know about this student?

Recommendation:
I strongly recommend this student.
I recommend this student.
I do not recommend this student.
I would like someone from AMIE to call me to discuss my recommendation.

Signature of Teacher/School Official________________________________

Date_________________________________________________________

The contact information (name, title, email, etc.) listed in the School Certification
section also applies to this section.
My contact information is different than the information listed in the School
Certification section. (If different, please provide below.)

Teacher’s/School Official’s Name

Title
Telephone
Email address
School Name
City/State/Zip
Country

If you would like to know more about the American Moroccan International
Exchange, please indicate below:
I would like more information about AMIE.
I would like a presentation in my class.

Thank you for your time and participation. Please feel free to contact AMIE if you
have any questions about this evaluation or our program.

Parent/Guardian Agreement
I am fully aware of all conditions of participation, and I support this application
and my daughter’s decision to take part in AMIE. If this application is accepted, I
agree to host a student when the AMIE summer exchange program is in my
country of residence, and to provide accommodation and meals for her for the
duration of the exchange.

□ I am providing the names of three family references with the understanding

that at least two of them will be contacted by an AMIE representative.

First and Last Names of Family Telephone Numbers:

References:

-4-
□ I am unable to provide three family references and request a personal
interview with the group organizer.

I understand that the contents of this application will remain confidential.

Signature of Parent/Guardian______________________________________
Date__________________________________________________________

Student Agreement
I have discussed the AMIE Summer Exchange Program with my
parent(s)/guardian(s). The information I have provided in my application
materials is complete and truthful to the best of my knowledge. I agree to
accept all terms and conditions of the Program and follow all rules, regulations
and conditions set forth by AMIE for participation. I will make every effort to
participate to the best of my ability.

Signature of Applicant___________________________________________
Date_________________________________________________________

Remember…
Please submit your application with your 700-word essay and Host Family Application
form (if applicable).

For More Information

If you have any questions, please contact us at info@amieonline.org

American Moroccan International Exchange

17510 Issaquah Hobart RD SE
Issaquah, WA 98027
USA

Phone from the US: 1.425.427.5799

Phone from Morocco: 00.1.425.427.5799

Fax completed form to AMIE (US): 1-207-470-5799

Thank You!
Thank you for your interest in the AMIE Summer Exchange Program! An AMIE
representative will contact you to discuss next steps.

-5-