PLACEMENT CONFIRMATION
STUDENT
Last Name: {{!empty($my_application['inputLastName'])? $my_application['inputLastName']:''}}
First Name: {{!empty($my_application['inputFirstName'])? $my_application['inputFirstName']:''}}
English Name (If Applicable): {{!empty($my_application['inputEngName'])? $my_application['inputEngName']:''}}
Birthdate: {{!empty($my_application['selectStudentBirth'])? $my_application['selectStudentBirth']:''}}
Grade: {{!empty($my_application['inputGrade'])? $my_application['inputGrade']:''}}
Gender: {{!empty($my_application['radioGender'])? $my_application['radioGender']:''}}
Phone: {{!empty($my_application['inputPhone'])? $my_application['inputPhone']:''}}
Email: {{!empty($my_application['inputEmail'])? $my_application['inputEmail']:''}}
Address: {{!empty($my_application['inputAddress'])? $my_application['inputAddress']:''}}
PLACEMENT
Host family status: {{!empty($my_application['radioHostStatus'])? $my_application['radioHostStatus']:''}}
Replacement? {{!empty($my_application['radioReplacement'])? $my_application['radioReplacement']:''}}
Placement Date: {{!empty($my_application['selectPlacementDateBirth'])? $my_application['selectPlacementDateBirth']:''}}
Move-In Date: {{!empty($my_application['inputMID'])? $my_application['inputMID']:''}}
For office use only: {{!empty($my_application['inputOfficeUseOnly'])? $my_application['inputOfficeUseOnly']:''}}
HOST PARENTS
Host Mom Name
{{!empty($my_application['inputHostMomName'])? $my_application['inputHostMomName']:''}}
Occupation
{{!empty($my_application['inputHostMomCareer'])? $my_application['inputHostMomCareer']:''}}
Host Dad Name
{{!empty($my_application['inputHostDadName'])? $my_application['inputHostDadName']:''}}
Occupation
{{!empty($my_application['inputHostDadCareer'])? $my_application['inputHostDadCareer']:''}}
HOUSEHOLD MEMBERS
Name
Gender
Relation / Occupation
Grade / Employer
Lives at home?
{{!empty($my_application['inputHHName1'])? $my_application['inputHHName1']:''}}
{{!empty($my_application['inputHHGender1'])? $my_application['inputHHGender1']:''}}
{{!empty($my_application['inputHHJob1'])? $my_application['inputHHJob1']:''}}
{{!empty($my_application['inputGE1'])? $my_application['inputGE1']:''}}
{{!empty($my_application['inputLiveHome1'])? $my_application['inputLiveHome1']:''}}
{{!empty($my_application['inputHHName2'])? $my_application['inputHHName2']:''}}
{{!empty($my_application['inputHHGender2'])? $my_application['inputHHGender2']:''}}
{{!empty($my_application['inputHHJob2'])? $my_application['inputHHJob2']:''}}
{{!empty($my_application['inputGE2'])? $my_application['inputGE2']:''}}
{{!empty($my_application['inputLiveHome2'])? $my_application['inputLiveHome2']:''}}
{{!empty($my_application['inputHHName3'])? $my_application['inputHHName3']:''}}
{{!empty($my_application['inputHHGender3'])? $my_application['inputHHGender3']:''}}
{{!empty($my_application['inputHHJob3'])? $my_application['inputHHJob3']:''}}
{{!empty($my_application['inputGE3'])? $my_application['inputGE3']:''}}
{{!empty($my_application['inputLiveHome3'])? $my_application['inputLiveHome3']:''}}
Home Address, City, State: {{!empty($my_application['inputHHAddress'])? $my_application['inputHHAddress']:''}}
Email: {{!empty($my_application['inputMomEmail'])? $my_application['inputMomEmail']:''}} {{ empty($my_application['inputMomEmail'])&&!empty($my_application['inputDadEmail'])? $my_application['inputDadEmail']:''}}
Phone: {{!empty($my_application['inputHHPhone'])? $my_application['inputHHPhone']:''}}
Have own room? {{!empty($my_application['inputHHOwnRoom'])? $my_application['inputHHOwnRoom']:''}}
Nearest International Airport: {{!empty($my_application['inputHHNearAirPort'])? $my_application['inputHHNearAirPort']:''}}
Pets? {{!empty($my_application['inputHHPet'])? $my_application['inputHHPet']:''}}
Pet Information: {{!empty($my_application['inputHHPetInfo'])? $my_application['inputHHPetInfo']:''}}
SCHOOL
Name: {{!empty($my_application['inputSchName'])? $my_application['inputSchName']:''}}
School type: {{!empty($my_application['inputSchType'])? $my_application['inputSchType']:''}}
Address: {{!empty($my_application['inputSchAddress'])? $my_application['inputSchAddress']:''}}
Phone: {{!empty($my_application['inputSchPhone'])? $my_application['inputSchPhone']:''}}
Fax: {{!empty($my_application['inputSchFax'])? $my_application['inputSchFax']:''}}
Website: {{!empty($my_application['inputSchWebsite'])? $my_application['inputSchWebsite']:''}}
Fall semester starts: {{!empty($my_application['inputSchFSS'])? $my_application['inputSchFSS']:''}}
Spring semester starts: {{!empty($my_application['inputSchSSS'])? $my_application['inputSchSSS']:''}}
REPRESENTATIVES
Local Coordinator Name/Phone/Email: {{!empty($my_application['inputLCName'])? $my_application['inputLCName']:''}} / {{!empty($my_application['inputLCPhone'])? $my_application['inputLCPhone']:''}} / {{!empty($my_application['inputLCEmail'])? $my_application['inputLCEmail']:''}}
Program Director Name/Phone: {{!empty($my_application['inputLCSName'])? $my_application['inputLCSName']:''}} / {{!empty($my_application['inputLCSPhone'])? $my_application['inputLCSPhone']:''}}
Emergency Phone Number: 1 888-361-8588
Emergency Email Address: contact@anbeducation.com
| STUDENT | ||
|---|---|---|
| Last Name: {{!empty($my_application['inputLastName'])? $my_application['inputLastName']:''}} | First Name: {{!empty($my_application['inputFirstName'])? $my_application['inputFirstName']:''}} | English Name (If Applicable): {{!empty($my_application['inputEngName'])? $my_application['inputEngName']:''}} |
| Birthdate: {{!empty($my_application['selectStudentBirth'])? $my_application['selectStudentBirth']:''}} | Grade: {{!empty($my_application['inputGrade'])? $my_application['inputGrade']:''}} | Gender: {{!empty($my_application['radioGender'])? $my_application['radioGender']:''}} |
| Phone: {{!empty($my_application['inputPhone'])? $my_application['inputPhone']:''}} | Email: {{!empty($my_application['inputEmail'])? $my_application['inputEmail']:''}} | |
| Address: {{!empty($my_application['inputAddress'])? $my_application['inputAddress']:''}} | ||
| PLACEMENT | ||
| Host family status: {{!empty($my_application['radioHostStatus'])? $my_application['radioHostStatus']:''}} | Replacement? {{!empty($my_application['radioReplacement'])? $my_application['radioReplacement']:''}} | |
| Placement Date: {{!empty($my_application['selectPlacementDateBirth'])? $my_application['selectPlacementDateBirth']:''}} | Move-In Date: {{!empty($my_application['inputMID'])? $my_application['inputMID']:''}} | |
| For office use only: {{!empty($my_application['inputOfficeUseOnly'])? $my_application['inputOfficeUseOnly']:''}} | ||
| HOST PARENTS | ||||
|---|---|---|---|---|
| Host Mom Name | {{!empty($my_application['inputHostMomName'])? $my_application['inputHostMomName']:''}} | |||
| Occupation | {{!empty($my_application['inputHostMomCareer'])? $my_application['inputHostMomCareer']:''}} | |||
| Host Dad Name | {{!empty($my_application['inputHostDadName'])? $my_application['inputHostDadName']:''}} | |||
| Occupation | {{!empty($my_application['inputHostDadCareer'])? $my_application['inputHostDadCareer']:''}} | |||
| HOUSEHOLD MEMBERS | ||||
| Name | Gender | Relation / Occupation | Grade / Employer | Lives at home? |
| {{!empty($my_application['inputHHName1'])? $my_application['inputHHName1']:''}} | {{!empty($my_application['inputHHGender1'])? $my_application['inputHHGender1']:''}} | {{!empty($my_application['inputHHJob1'])? $my_application['inputHHJob1']:''}} | {{!empty($my_application['inputGE1'])? $my_application['inputGE1']:''}} | {{!empty($my_application['inputLiveHome1'])? $my_application['inputLiveHome1']:''}} |
| {{!empty($my_application['inputHHName2'])? $my_application['inputHHName2']:''}} | {{!empty($my_application['inputHHGender2'])? $my_application['inputHHGender2']:''}} | {{!empty($my_application['inputHHJob2'])? $my_application['inputHHJob2']:''}} | {{!empty($my_application['inputGE2'])? $my_application['inputGE2']:''}} | {{!empty($my_application['inputLiveHome2'])? $my_application['inputLiveHome2']:''}} |
| {{!empty($my_application['inputHHName3'])? $my_application['inputHHName3']:''}} | {{!empty($my_application['inputHHGender3'])? $my_application['inputHHGender3']:''}} | {{!empty($my_application['inputHHJob3'])? $my_application['inputHHJob3']:''}} | {{!empty($my_application['inputGE3'])? $my_application['inputGE3']:''}} | {{!empty($my_application['inputLiveHome3'])? $my_application['inputLiveHome3']:''}} |
| Home Address, City, State: {{!empty($my_application['inputHHAddress'])? $my_application['inputHHAddress']:''}} | Email: {{!empty($my_application['inputMomEmail'])? $my_application['inputMomEmail']:''}} {{ empty($my_application['inputMomEmail'])&&!empty($my_application['inputDadEmail'])? $my_application['inputDadEmail']:''}} Phone: {{!empty($my_application['inputHHPhone'])? $my_application['inputHHPhone']:''}} |
|||
| Have own room? {{!empty($my_application['inputHHOwnRoom'])? $my_application['inputHHOwnRoom']:''}} | Nearest International Airport: {{!empty($my_application['inputHHNearAirPort'])? $my_application['inputHHNearAirPort']:''}} | |||
| Pets? {{!empty($my_application['inputHHPet'])? $my_application['inputHHPet']:''}} | Pet Information: {{!empty($my_application['inputHHPetInfo'])? $my_application['inputHHPetInfo']:''}} | |||
| SCHOOL | ||||
| Name: {{!empty($my_application['inputSchName'])? $my_application['inputSchName']:''}} | School type: {{!empty($my_application['inputSchType'])? $my_application['inputSchType']:''}} | |||
| Address: {{!empty($my_application['inputSchAddress'])? $my_application['inputSchAddress']:''}} | ||||
| Phone: {{!empty($my_application['inputSchPhone'])? $my_application['inputSchPhone']:''}} | Fax: {{!empty($my_application['inputSchFax'])? $my_application['inputSchFax']:''}} | |||
| Website: {{!empty($my_application['inputSchWebsite'])? $my_application['inputSchWebsite']:''}} | ||||
| Fall semester starts: {{!empty($my_application['inputSchFSS'])? $my_application['inputSchFSS']:''}} | Spring semester starts: {{!empty($my_application['inputSchSSS'])? $my_application['inputSchSSS']:''}} | |||
| REPRESENTATIVES | ||||
| Local Coordinator Name/Phone/Email: {{!empty($my_application['inputLCName'])? $my_application['inputLCName']:''}} / {{!empty($my_application['inputLCPhone'])? $my_application['inputLCPhone']:''}} / {{!empty($my_application['inputLCEmail'])? $my_application['inputLCEmail']:''}} | ||||
| Program Director Name/Phone: {{!empty($my_application['inputLCSName'])? $my_application['inputLCSName']:''}} / {{!empty($my_application['inputLCSPhone'])? $my_application['inputLCSPhone']:''}} | ||||
| Emergency Phone Number: 1 888-361-8588 | Emergency Email Address: contact@anbeducation.com | |||