Returnee Questionnaire

Student Name

First Last

Student Email

Student Contact number

Parent Name

First Last

Parent Email

Parent Contact number

Home Town/City

Date of Birth

Nationality (as per passport)

Country of Residence

Country of Birth

Gender

Female
Male
Other

Current Year at School

Have you ever been home-schooled?

Yes - for more than one year
Yes - for less than one year
No

This does not include schooling from home due to lockdown or self-isolation due to COVID.

Chosen destination for exchange

Chosen program length

2 - 3 months
5 months
10 months
Other

Chosen departure date

Do you have at least a C/5 grade average in the last 3 years of school?

Yes
No
Not sure

If you have chosen a non-English speaking destination, how many years of experience do you have with the local language?

Do you have asthma or allergies? Please list your allergies

Please list any dietary requirements

Have you ever been treated for a mental or physical illness?

Yes
No

Unfortunately, some destinations are unable to accept students with certain mental or physical illnesses. If you answer yes to this question, our staff will contact you for more information so that we can accurately advise you about your eligibility.

Do you have a learning difficulty e.g. dyslexia, dyspraxia.

Yes
No

Have you discussed this application with your parents?

Yes
No

Have you discussed this application with your school/college?

Yes
No

Please confirm by ticking the box below that you have read and understood the Privacy Notice and that you consent to the personal information described being collected and processed by My Education (UK) Limited for the reasons given.

Consent*

I have read and understood the Privacy Notice

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Returnee Questionnaire

Returnee Questionnaire

High School Pre-Application Form