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Global Cow, Ltd.
611 Ames Hill, Brattleboro, VT 05301
tel: (802) 254-2879
jill@globalcow.com
Skype: jillstahltyler
www.globalcow.com
We’ll share all of your information in this application others. Please complete fully and carefully--in English!
CONTACT INFORMATION
*Names need to match your passport exactly.
First name
*
Middle name
*
Surname
*
Physical street number and name (to receive mail)
*
City
*
State/province/region
*
Zip code
*
Country
*
Telephone
*
Cell phone
*
Email
*
Please email me updates & newsletter.
MEDICAL CONTACT
Medical emergency contact name
*
Relationship
*
Telephone number
*
TRAVEL LENGTH & TIMES
When do you want to travel?
*
Where do you want to travel to?
*
How long do you want to stay?
*
BIOGRAPHICAL INFORMATION
Gender
*
Male
Female
Age
*
Birthday (
Month, day, year)
*
Height
*
Weight
*
Passport number
*
Martial status
*
Single
Married
Divorced
Children?
*
Yes
No
EDUCATION
Name of college or university you are enrolled in, or have graduated from:
*
Degree you will graduate with
*
Expected or actual graduation date
*
Type of work you hope to do with this degree and education
*
LANGUAGES
What is your native language?
*
Languages you speak
*
How long have you spoken English?
*
Please rank your SPOKEN/ORAL English skills
*
Excellent
Very good
Good
Fair
Poor
Please rank your WRITTEN English skills
*
Excellent
Very good
Good
Fair
Poor
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Global Cow, Ltd.
611 Ames Hill Road; Brattleboro, VT 05301 USA
Tel: (802) 254-2879 Tollfree--in USA only: (866) 267-2879
email: info@globalcow.com web:
www.globalcow.com