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Personal Information

NAME
ADDRESS
CITY
STATE ZIP
HOME TEL. WORK TEL.
CELL    
FAX
EMAIL

Which program are you applying for:
YES FLEX PAX

 

Where did you hear about us?

If Local Newspapers
Please list the local newspaper(s) in which you heard about us

 

Education
Please list name of school(s), years completed, year graduated and degree awarded.

 

Employment History
Please list employer, position, dates employed and reasons for leaving (list current or most recent job first).

 

Volunteer or Related Experience
Please list organization, position and dates/length of service.

 

Experience with Youth
Describe any experience you have had working with teens and families. Do you know teens? Do you enjoy working with them?

 

Have you ever served or are you currently serving as a representative for another high school exchange program? If yes, please explain.

 

Have you ever hosted a foreign student?
If yes, when did you host, how many students did you host and from which country did they come?

 

Background Information
Is there any history of child abuse, sexual abuse or emotional abuse in your family background? If yes, please explain.

Is there anything in your background or current situation that would call into question your working with youth? If yes, please explain.

Area High Schools
List those high schools in which you would like to enroll PAX students.

 

Recruiting Host Families
Highlight any professional or volunteer experience that would be particularly useful in the coordinator position as you understand it. You might include sales experience, professional associations, community or religious activities.

 

Motivation
Please tell us why you would like to become a PAX Community Coordinator. What would you like to contribute to the program? What benefits and rewards would you like to receive from your participation?

 

References
Please provide two references who are not family members, one personal and one professional.

FIRST REFERENCE
RELATIONSHIP
YEARS KNOWN
HOME TEL.
WORK TEL.
EMAIL

SECOND REFERENCE
RELATIONSHIP
YEARS KNOWN
HOME TEL.
WORK TEL.
EMAIL



To expedite your inquiry, please call or e-mail PAX to confirm that your application was received.