REGISTRATION

Student First Name
Student Last Name
 
 
Gender
   
       
Address
City
 
 
State
Zip
 
 
Home Number
Cell Number
 
 
Student Email
   
       
Host Family Name
Host Family Email
 
 
Food Allergies/ Preferences
   
       
Visa or Social Security Number
   
 
 
Agency
Agency Coordinator Name
 
 
Agency Coordinator Email
   
       
Room Mate Requested
Home Country
       
       
Class
       
   
 
       
If you receive an error when submitting this form please  click HERE to download the registration form and fax or mail it to :
Au Pair Program
P.O. Box 4822
Upper Marlboro, Maryland 20775
The mission of Sojourner Douglass College Division of Professional and Continuing Studies is to meet the needs of those wanting to increase professional competence or prepare for new jobs or careers, and those seeking to pursue personal interests..