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Preliminary Application
If you are interested in becoming a VIA International Exchange Student, please complete this Preliminary Application form and submit it to VIA. 
Program Length:    
Program Type:     
Participation Start Date:
VIA Overseas Agency Name (if Any):
Student Full Name (Surname and Given Name):    
Gender:
Birthdate:
Current Age:
Current Grade:
Do you smoke?:
Address:    
Email:    
Home Phone:
Cell Phone:
Current Grade Point Average: 
Last year's Grade Point Average:
Mother's Name (if under 18 yrs old):
Father's Name (if under 18 yrs old):
Please List Foreign Languages you have studies and how many years for each language:
Do you have any health problems or disabilities that would prevent you from being considered? If yes, explain:
Religious Preference (if any):
Consider yourself to be religiously:
Once this form is received, VIA Regional Directors will send you the full application
Final Program Fee Payments are to be made by Bank Transfer, Money Order, or Check
Brief Comment or Specific Question:
Name of Current School:
Address:
Name of person(if any) that told you about VIA:
What are your favorite subjects?:
What are the least favorite subjects?:
Sports that you are active in:
Countries that you have traveled to:
Hobbies and Interests outside of school:
Tell us briefly why you want to participate in one of VIA's programs:
Give at least 5 words your friends would use to describe you (kind , fun, independent...):
How did you hear about Student Exchange Programs at VIA?
By pressing the submit button, you agree that all information submitted is accurateyou are the student, and have permission by your parent(s)/Legal Guardian to send this preliminary application:
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Preliminary Application for VIA Programs
This application can be used for any VIA Programs for students interested in short term, school, college, or university programs.
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