Jordan Language Academy - Amman, Jordan

Guest Student Application

About you

Family name *:

Given names *:

Gender *

male

female

date of birth *:

Address

City /Suburb

Province/State

Postal Code

Country Please Note: Include your country and area codes e.g. +65 99999 9999

Home phone

Fax number

Email *:

Confirm Email *:

Religion *:

Your health & diet...

Smoker

Allergies

Dietary needs

Your family...

Father's details

Occupation

Father's name

Mother's details

Occupation

Mother's name

Parent's Address

Please Note: Include your country and area codes e.g. +65 99999 9999 Home phone

Fax number

Emergency Contact In case we can't reach your parents... Name

Home phone

Relationship

About your trip...

Arrival Date

Arrival Time

Airline

Flight Number

Airport transfer (one-way only)

Length of stay

Application Form

The information you provide in this Application will assist us to place you with a suitable host family. Our goal is to ensure that your stay in Jordan is as memorable an experience as possible for you, an experience you can remember and cherish your entire life.

Fields marked with (*) are required.

I understand that by submitting my Application to Home stay ( Jordan Language Academy) that I will be bound by the Home stay Terms and Conditions and any additional terms and conditions advised to me either electronically or in writing from time to time by Home stay( Jordan Language Academy )