Student Sign-up for Exchange Trips

Center for Cultural Perspectives

Student Sign-Up Form for Intercultural Exchange Trips
Your Name:*

First Name, M.I.Last Name
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
La Salle Email:*
example@example.com
Phone Number:*
Gender:*
Your Current Grade Level:*
Your Current Counselor:*
Your Current Mentor:*
Are you a Student Host for international visiting students?:
If Yes, When?:
If No, would you like to become one?:
Are you a Lasallian Ambassador on campus?
At the present time, what are your overall educational goals? *
Which trip or destination are you interested in signing up?*
If you are interested in multiple trips or destinations, please indicate your 1st & 2nd choices
What do you expect to learn and achieve through the trip(s)?*
After submission, please make an appointment with Ms. Sun to meet in person via email at jsun@lasallehs.org or by phone at 626-696-4389, or simple stop by Room #350. Please also feel free to ask her any questions.
Should be Empty:

Center for Cultural Perspectives