Cultural Trip Application – Cumberland Community School

Student Information

Current Age:*

Student Email:*

Phone:*

School:*

Current Grade:*

Country of Legal Residence:*

Country of Citizenship:*

Note passport must be valid through October 5, 2025. If it is not, please apply for a new passport by Summer 2024.

Guardian / Parent #1 Information

Parent/Guardian #1 Email*

Phone:*

Occupation:*

Relationship To Student*

Guardian / Parent #2 Information

Parent/Guardian #2 Email*

Phone:*

Occupation:*

Relationship To Student*

Interests & Preferences - To Be Completed By Student

Do you have any special skills your are proud to share?

Describe yourself as if introducing yourself to your host family, what are your interests, what is your family like and activities you like to do. What do you wish to achieve by participating in this experience?*

(Max 250 Words)

What do you do when faced with an uncomfortable situation…

1. When you are with your friends/peers?*

2. When you are with your family?*

3. When you are on your own?*

With a lot of interest in this experience and many people applying, why should you be chosen?*

If your friends are not chosen for this experience, are you still willing/wanting to go?*

Student Travel History

Where have you travelled outside of Canada?*

What activities do you like to do while travelling?*

Medical & Dietary Information - To Be Completed By Student & Parent(s)

Medical History

A medical history will not limit your participation, but chaperones need to be fully aware of your medical history and any medications you take regularly. Any medical conditions need to be stable according to the time restrictions/ limitations as stated in medical travel insurance.

Details of Illness or medical condition/ injury:

Describe any health issue that required medical attention or hospitalization in the last two years:

Do you have any medication you need to take with you?*

Are you able to manage this medication on your own?*

List the Foods you like:*

List the Foods you dislike:*

Food allergies or specialized dietary needs:*

Short Note to Exchange Student Buddy - To Be Completed By Student

Please write a short note to your sister school buddy. Describe yourself, what you are interested in, your family, pets, the activities you like to do. Describe your typical school day, evenings and weekends. What has made you interested to be a part of the cultural exchange? Describe some things you are hoping to do in China, and some things you hope to do with your host buddy while here.*

(Max 300 words)

Parent Confirmations - To Be Completed By Parent

Fundraising Questions - To Be Completed By Parent

Fundraising for Exchanges is Optional for raising some money toward offsetting individual costs of participating in the exchange.

Please note, there is no guarantee of raising significant funds through fundraising, and it must be parent and student driven. The exchange lead teacher will help facilitate / sponsor some fundraising activities. Parents must have arranged to have full funds organized for the exchange in case fundraising initiative/ interest is low.

I have some great fundraising ideas, here they are:

What is a reasonable goal amount you hope your child can fundraise?

Passport Upload

If your passport is valid through October 5, 2025, please upload a scanned colour copy of the ID picture page here:*

Max. file size: 20 MB.

Questions or Comments:

Please review your submission before you hit submit