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Fast Application for Au Pair Students

Fields marked with an asterisk (*) are required.

Personal Information

First Name*

Preferred Name

Middle Name

Last Name*

Legal Sex*

Legal Sex*

Female

Male

Social Security Number

Birthdate*

Birthdate*

Permanent Address*

Permanent Address*

Country

Street

City

Region

Postal Code

Permanent Telephone*

Email Address*

Mailing Address*

Mailing Address*

Country

Street

City

Region

Postal Code

Race/Ethnicity
Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions. View Definitions

Are you Hispanic?*

Are you Hispanic?*

Yes

No

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:*

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:*

Native Hawaiian or Other Pacific Islander, White

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific

White

Choose Not to Respond

American Indian or Alaska Native, Asian

American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White

American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, White

American Indian or Alaska Native, Black or African American

American Indian or Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander, White

American Indian or Alaska Native, Black or African American, White

American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, White

American Indian or Alaska Native, White

Asian, Black or African American

Asian, Black or African American, White

Asian, Native Hawaiian or Other Pacific Islander

Asian, Native Hawaiian or Other Pacific Islander, White

Asian, White

Black or African American, Native Hawaiian or Other Pacific Islander

Black or African American, White

Native Hawaiian or Other Pacific Islander, White

Primary citizenship:*

Planned enrollment period*

Have you previously attended Notre Dame College?*

Have you previously attended Notre Dame College?*

Yes

No

Au Pair Information

Host Family Information

Host Family Contact First Name*

Host Family Contact Last Name*

Host Family Contact Phone Number*

Host Family Contact E-mail*

Agency Information

Agency Name*

Agency Contact First Name*

Agency Contact Last Name*

Agency Contact Phone Number*

Agency Contact E-mail*

Authorization and Signature

I certify that the information supplied by me on this application is true and correct to the best of my knowledge. By submitting this application, I hereby authorize Notre Dame College to obtain additional information regarding any and all academic and criminal records related to my disclosures on this application.

In addition, I authorize Notre Dame College to communicate pertinent information regarding the required Letter of Completion with the designated Au Pair Services Agency.

Checking this box acts as your electronic signature and is a legal substitute for your actual signature.*

Checking this box acts as your electronic signature and is a legal substitute for your actual signature.*

Signature

Notre Dame College Title IX Statement on Non-Discrimination:
Notre Dame College does not discriminate on the basis of race, color, national origin, gender, sexual orientation, disability, genetic information, or age in its programs and activities. The policy extends to employment with and admission to the college.

Student Type - Au Pair (Hidden)

Round (Hidden)

App Round Always Create (Hidden)

Application Submitted Flag (Hidden)

PIN Generation (Hidden)

Degree is Non Degree Seeking (Hidden)

Major is Non Degree Seeking (Hidden)

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1-877-632-6446

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