Student Application Student Application Now accepting applications for 20 spots on our student trip June 18- July 2, 2019! If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Student Name (as listed on Passport) * Date of Birth * MaleFemale * Student's E-mail * Student's Phone * Address 1 * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code * Please list your top 3 preferred airports to fly out of: * Parent's Name * Parent's E-mail * Parent's Phone * Name of School or Homeschool * How long have you attended this school or high school? * How did you hear about the Orvieto Program? * When will you graduate from high school? * What are your favorite academic subjects? * Do you have any physical limitations that we should be aware of? YesNo Please explain: Any dietary restrictions that we should be aware of? YesNo Please list them here: Do you take any medications? YesNo Do you have any emotional concerns including fear of flying, anxiety, or depression that we should be aware of? YesNo Please explain: Have you been apart from your family before? YesNo If yes, please explain: Have you ever traveled to Europe before? YesNo What country? Please tells us why you would enjoy participating in the Orvieto Program. * Please provide the following information for a reference. The reference could be someone from your school, co-op, neighborhood, church, or work. First Name * Last Name * Email * Phone * How do you know this reference? * Do we have permission to use any photos taken of you while on the Orvieto Trip? YesNo