Address of the workplace/school Phone: Fax: E-mail: Major/Field: Highest qualification attained Experience in youth activities Experience in international exchange programs (Countries, activity details, etc.) First language and other First Language: Other: spoken languages Religion (Denomination) ( ) Reason: Dietary restrictions, allegies, etc. Allergies/Other: Medical History: Please list any prescription medication Medical History/Prescription you are currently taking: Medicine Smoker Yes No Experience in SWY or GLDP Yes (Year: ) No program Listening None Daily Native Speaker Conversation English Ability Level Speaking None Daily Native Speaker Conversation Listening None Daily Native Speaker Conversation Japanese Ability Level Speaking None Daily Native Speaker Conversation
Address of the workplace/school Phone: Fax: E-mail: Highest qualification attained Major/Field: Experience in youth activities Experience in international exchange programs (Countries, activity details, etc.) First language and other spoken languages First Language: Other: Religion (Denomination) ( ) Dietary restrictions, allegies, etc. Reason: Allergies/Other: Medical History/Prescription Medicine Medical History: Please list any prescription medication you are currently taking: Smoker Yes No Experience in SWY or GLDP program Yes (Year: ) No English Ability Level Listening None Daily Conversation Native Speaker Speaking None Daily Conversation Native Speaker Japanese Ability Level Listening None Daily Conversation Native Speaker Speaking None Daily Conversation Native Speaker
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