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