Starlink Payton Global Program Application

www.starlinkglobaleducation.org/payton_en/

July 19 – August 3, 2014

Name: __________________________________________

School: __________________________________________

Grade: _____________ Advisory teacher: _____________________

Email: __________________________________________

Phone: __________________________________________

Home Address: _______________________________________________

Were you referred by another student? List name below.Student name: ________________________________________________

Please check as many answers as apply in your situation:

_____ 1) If accepted into the program, I am willing and able to host one Chinese student in my home, and I will pay $400 for tuition, including field trips.

_____ 2) If accepted into the program, I am willing and able to host two Chinese students of the same gender in my home, and my tuition fee will be waived entirely.

_____ 3) I am willing to participate in the program but prefer not to host a Chinese student. I will pay $800 in tuition, including field trips.

Parent Signature: ______________________________________________

Student Signature: _____________________________________________

Using no more than 6 sentences, please explain why you would like to participate in the Starlink Payton Global program:_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

If you join the program with a friend who is new to the program, you will receive a

$25 referral fee.

I referred ___________________________________ (name) to the program.