Salutation
-None-
Mr.
Mrs.
Ms.
Dr.
Prof.
First Name* Last Name* Preferred Name Sex at Birth*
-None-
Male
Female
Additional Gender Information Age* Birthdate* Interest Sheet Done
-None-
No
Yes
Street* City* StateDropDown
-None-
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
DC
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code* Country* Email* Mobile* Home Phone Skype ID In what Countries do you hold citizenship? I am currently a -
-None-
None
High School Student
High School Graduate
College Student
College Graduate
Mid-career Professional
Retiree
Name of High School High School Graduation Year Name of College College Graduation Year Graduate Studies Parents' Marital Status
-None-
Married
Separated
Divorced
Other
Parent 1 First Name Parent 1 Last Name Parent 1 Occupation Parent 1 Cell Phone Parent 1 Email* Parent 2 First Name Parent 2 Last Name Parent 2 Occupation Parent 2 Cell Phone Parent 2 Email Brothers or Sisters
-None-
Yes
No
Sibling Names & Ages Do you have any known allergies? If so, name them Tell us of any dietary restrictions or preferences Tell us of any physical, medical or other issues Are you on medication? If so, which and for what? Have you been hospitalized in the past 3 years? How did you hear about us?
-None-
An Interim Client Family
Book Directory
College Office
Education Consultant
Family Member
Gap Fair
High School Counselor
Internet
LEAPNow
News Article
Other
Psychiatrist
Psychologist
School Presentation
Word-of-Mouth
If 'Other' please be specific When would you like to begin & for how long? What work and/or volunteer positions have you had? What hobbies do you have? What do you enjoy? What subjects in & out of school have you enjoyed? What languages have you studied and for how long? Where have you travelled in the U.S. and abroad? What organized programs outside of school or work?
In the Multiple Selection Boxes Below Select Those that Might Interest You on Your Gap Year
North America (USA & Canada)
Alaska
Appalachia
Canada
Hawaii
Midwest
Northeast
Northwest
Southeast
Southwest
The Rockies
Europe
Austria
Eastern EU
England/UK
France
Germany
Greece
Ireland
Italy
ScandinaviaNetherlands
Spain
Switzerland
Central America
Belize
Caribbean
Costa Rica
Guatemala
Mexico
Nicaragua
South America
Argentina
Bolivia
Brazil
Chile
Ecuador
Peru
North Africa
Egypt
Morocco
West Africa
Cameroon
Ghana
Senegal
East Africa
Kenya
Tanzania
Uganda
Southern Africa
Botswana
Madagascar
Namibia
South Africa
Asia
China
India
Japan
Nepal
Thailand
Vietnam
Oceania
Australia
Fiji
Indonesia
Micronesia
New Zealand
Middle East
Israel
Jordan
Turkey
Other Geographic Locations Lifestyle
Homestay
Independent
Indoor
Outdoor
Peer Group
Rural
Urban
Program Type
Academic
Cultural Immersion
Experiential
Internship
Skill Based
Volunteer
Work Exchange
Animals
Big Cats
Birds
Dolphins
Domestic
Elephants
Horses
Penguins
Primates
Sea Turtles
Sled Dogs
Whales
Wild
Arts
Art History
Blacksmith
Ceramics
Cooking
Drawing
Glasswork
Graphic Design
Jewelry
Metal
Painting
Photography
Sculpture
Textiles
Woodcraft
Writing
Building
Architecture
Boats
Construction
Natural Bldg
Restoration
Environmental Study
Field Research
Forestry
Marine Biology
Media
Computers
Film
Radio
Recording
Video/TV
Music
Drums
Guitar
Guitar Making
Horns
Piano
Voice
Performance
Comedy
Dance
Production
Theater
Professional
Business
Event Plans
Fashion
Hotel Mgmt
Journalism
Medical
Museum
Politics
Restaurant
Technology
Veterinary
Zoo/Aquarium
Outdoor Skills
Backpacking
Canoeing
Kayaking
Outdoor Leadership
Rock Climbing
Sailing
SCUBA
Skiing
Snow Boarding
Surfing
Survival
Wilderness Medicine
Spiritual Disciplines
Buddhism
Faith-based Service Work
Healing Arts
Martial Arts
Native American
Yoga/Meditation
Languages
Arabic
French
German
Italian
Other
Portuguese
Spanish
Enter Other Languages Here Volunteering
Animals
Anthropology
Archaeology
Children
Elder Care
Environmental Conservation
Healthcare
Human Rights
Organic Farming
Ranching
Special Needs
Sports
Teaching
Trail Building
Wildlife Conservation
Other If you could do anything on a GY what would it be? Captcha: Please type what you see
Reload