短期项目信息表 Short Term Program Information Form AGENCY CONTACT INFORMATIONAgent Name(Required) Country(Required) Email Address(Required) Cell Phone(Required) Agency Name(Required) Address 街道地址 地址2 (街道) 市 州/省/地区 邮编/邮政编码 * 澳门AnguillaArubaBonaire, Sint Eustatius and SabaBouvet IslandBritish Indian Ocean TerritoryBrunei DarussalamChristmas IslandCocos IslandsCook IslandsCzechiaDeutschland (德国)EswatiniFalkland IslandsFrench GuianaGibraltarGuadeloupeHoly SeeKorea, Democratic People's Republic ofKorea, Republic ofLao People's Democratic RepublicMartiniqueMayotteMontserratNew CaledoniaNiueNorfolk IslandNorth MacedoniaPitcairnRussian FederationRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint MartinSaint Pierre and MiquelonSouth Georgia and the South Sandwich IslandsSouth SudanSvalbard and Jan MayenSyria Arab RepublicTanzania, the United Republic ofTokelauTurks and Caicos IslandsTürkiyeUS Minor Outlying IslandsViet NamWallis and FutunaWestern SaharaМонгол улс (蒙古)မြန်မာ (缅甸)不丹东帝汶中国中非共和国丹麦乌克兰乌兹别克斯坦乌干达乌拉圭乍得乔治亚州也门亚美尼亚以色列伊拉克伊朗伯利兹佛得角保加利亚克罗地亚关岛冈比亚 (西非的独立国)冰岛几内亚几内亚比绍列支敦士登刚果刚果民主共和国的利比亚利比里亚加拿大加纳加蓬匈牙利北马里亚纳群岛南极洲南非博茨瓦纳卡塔尔卢旺达卢森堡印度印度尼西亚危地马拉厄瓜多尔厄立特里亚古巴台湾(中国)吉尔吉斯斯坦吉布提哈萨克斯坦哥伦比亚哥斯达黎加喀麦隆图瓦卢土库曼斯坦圣卢西亚岛圣基茨和尼维斯圣多美和普林西比圣文森特和格林纳丁斯圣马丁岛圣马力诺圭亚那埃及埃塞俄比亚基里巴斯塔吉克斯坦塞内加尔塞尔维亚塞拉利昂塞浦路斯塞舌尔群岛墨西哥多哥多米尼克多米尼加共和国奥兰群岛奥地利委内瑞拉孟加拉国安哥拉安提瓜岛和巴布达安道尔密克罗尼西亚尼加拉瓜尼日利亚尼日尔尼泊尔巴勒斯坦国巴哈马巴基斯坦巴巴多斯巴布亚新几内亚巴拉圭巴拿马巴林巴西布吉纳法索布隆迪希腊帕劳群岛库拉索开曼群岛意大利所罗门群岛拉脱维亚挪威摩尔多瓦摩洛哥摩纳哥斐济斯洛伐克斯洛文尼亚斯里兰卡新加坡新西兰日本智利柬埔寨根西岛格林纳达格陵兰比利时毛里塔尼亚毛里求斯汤加沙特阿拉伯法国法属南部领土法属波利尼西亚法罗群岛波兰波多黎各波斯尼亚和黑塞哥维那泰国泽西岛津巴布韦洪都拉斯海地澳洲爱尔兰爱沙尼亚牙买加特立尼达和多巴哥玻利维亚瑙鲁瑞典瑞士瓦努阿图白俄罗斯百慕大科威特科摩罗科特迪瓦秘鲁突尼斯立陶宛索马里约旦纳米比亚维尔京群岛,美国维尔京群岛,英国罗马尼亚美国美属萨摩亚肯尼亚芬兰苏丹苏里南河英国荷兰莫桑比克莱索托菲律宾萨尔瓦多萨摩亚群岛葡萄牙西班牙贝宁赞比亚赤道几内亚赫德岛和麦克唐纳岛阿塞拜疆阿富汗阿尔及利亚阿尔巴尼亚阿曼阿根廷阿联酋香港证券交易所马尔代夫马恩岛马拉维马来西亚马绍尔群岛马耳他马达加斯加马里黎巴嫩黑山共和国 国家 SHORT TERM PROGRAM & TRAVEL DETAILSArrival Date Departure Date Preferred Airport Preferred Program Location California Colorado Florida Illinois Indiana Kansas Maryland Minnesota Missouri Ohio Pennsylvania Virginia STUDENT DETAILSAges of Students Number of Students Citizenship of Students HOMESTAY DETAILSPlease check the number of student(s) per homestay. One student per home Two Students per home Combination of two, three or four students per home ITINERARYPlease select a Standardized Short Term Program ESL Camp– ESL classes, Excursions and Activities Homestay Immersion – Homestay only & activities with hosts Homestay Tutoring – Homestay, ESL study in home & activities with hosts School Experience – During September to May; attend school with U.S. students Public School Experience – During September to May; attend school with U.S. students, valid U.S. PASSPORT REQUIRED. ESL & TOEFL Preparation Camp Session (select one or more) Session 1 – June Session 2 – July Session 3 – August Agent Designed Customized Program: For groups of 10 or more students, AHLI can create a customized itinerary of activities to meet your wants and needs. Please describe the activities you would like included in your program. HEALTH AND ACCIDENT INSURANCEDo you desire AHLI to purchase the required student insurance ($2 per day per participant)? Yes No
