Interest Sheet


This Interest Sheet is to help you consider possible places to travel, interests to explore, and skills to develop on your gap year. We use it simply as a starting point for the initial free 90-minute brainstorming session. NOTE: Fields marked with asterisks are required.
  
This information is confidential and for Interim's use only. It will not be distributed or sold to third parties.
 
Please fill out the form below and click the "SUBMIT" button.

To select (or unselect) your choices in a multi-select drop-down box below, in Windows hold down the CTRL key, in MAC hold down the Command key, then click your choices.




Inquiry
Salutation
First Name*
Last Name*
Preferred Name
Sex at Birth*
Additional Gender Information
Age*
Birthdate*
Interest Sheet Done
Street*
City*
StateDropDown
Zip Code*
Country*
Email*
Mobile*
Home Phone
Skype ID
In what Countries do you hold citizenship?
I am currently a -
Name of High School
High School Graduation Year
Name of College
College Graduation Year
Graduate Studies
Parents' Marital Status
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
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?
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?
North America (USA & Canada)
Europe
Central America
South America
North Africa
West Africa
East Africa
Southern Africa
Asia
Oceania
Middle East
Other Geographic Locations
Lifestyle
Program Type
Animals
Arts
Building
Environmental Study
Media
Music
Performance
Professional
Outdoor Skills
Spiritual Disciplines
Languages
Enter Other Languages Here
Volunteering
Other
If you could do anything on a GY what would it be?
Captcha: Please type what you see
Reload
As a reminder, to select (or unselect) your choices in a multi-select drop-down box above, in Windows hold down the CTRL key, in MAC hold down the Command key, then click your choices.

Ready to get started?

Fill out our Interest Sheet for a free 90-minute consultation or Contact Us with general inquiries.
© 2018 Center for Interim Programs