USAuPair.com | AuPair Interest Form

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Au Pair Interest Form

Fields marked with asterisks (*) are required for the form to function properly.

Family Name*:

Given Name*:

Middle Name:

Age*:

Address:

Street

(Optional)

City*:

Country*:

Postal Code:

Daytime Phone*:

Evening Phone*:

E-Mail Address*:


May we contact you at your telephone number(s)?*	Yes No
May we contact you at your e-mail address?*	Yes No

Citizenship*:

If you have a second citizenship, list below:

Driver's License?*

Yes No Smoke?* Yes No

My English is*:

excellent good fair poor

Child Care Experience:

Under age two:

more than 200 hours less than 200 hours

Over age two:

more than 200 hours less than 200 hours

Best Departure Months:
January February March April May June
July August September October November

Comments:

in brief...
USAuPair is a U.S. State Department-designated sponsor for an au pair cultural exchange program. We bring to our program more than 20 years of experience in cultural exchange and hosting au pairs, including those for our own children.

interested?
If you are interested in learning more about our program, fill out our online .