Interest Sheet
This interest sheet/application form helps us to match your interests and goals with specific gap options and experiences that we will go over during the brainstorming session. 

The interest sections should be completed only by the gap year participant, thank you. (If you are a mid-career/retiree, please put N/A in required fields that aren't applicable.)
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Email *
First Name: *
Last Name: *
Preferred First Name:
Current Age: *
Birth Date *
MM
/
DD
/
YYYY
Gender at Birth: *
Other Gender Information (if applicable):
Cell Phone: *
Email: *
Street Address:
City: *
State: *
Zip Code: *
Country:
Citizenship(s):
I am currently a:
Clear selection
High School Name
High School Graduation Year
College Name & Graduation Year:
Graduate Studies & Graduation Year & Degree(s):
How did you hear about Interim? (check all that apply)
Parent 1 First Name: *
Parent 1 Last Name: *
Parent 1 Occupation: *
Parent 1 Cell Phone:
Parent 1 Email: *
Parent 2 First Name:
Parent 2 Last Name:
Parent 2 Occupation:
Parent 2 Cell Phone:
Parent 2 Email:
Step Parent(s) First & Last Name(s) & Occupation(s)
Step Parent(s) Cell Phone(s):
Step Parent(s) Email(s):
Parents' Marital Status:
Clear selection
Do you have brothers or sisters? If yes, please include names & ages:
Please list any allergies you have:
Any dietary restrictions/preferences?
Please tell us about any physical, medical, or psychological conditions for which you are currently being or have recently been treated, even if you don’t feel that it would affect your participation in a program. Examples include: depressive disorders, eating disorders, ADHD, diabetes, alcohol/drug/technology addictions, etc.
Are you on medication? If so, which and for what?
If you have been hospitalized in the past 3 years, what was it for?
When would you like to begin gap time and for how long?
Where have you traveled in the world?
What languages have you studied and for how long?
What hobbies do you have? What do you enjoy doing?
What work and/or volunteer positions have you held?
What subjects in and out of school have you liked?
What organized programs outside of school or work have you attended?
Do you have a budget in mind for your gap time?
Please check locations and areas of interest below which will help us pinpoint options for you.
(The countries included are ones where we have sent many students over the years.)
North America:
Africa:
Asia:
Southeast Asia:
Central America:
South America:
South Pacific:
Europe:
Middle East:
Additional specific locations or cities/towns of interest:
General Areas of Interest:
What languages might you like to focus on?
Are there any other areas of interest you would  like to explore?
Feel free to outline your ideal gap experience.
Please send a photo of yourself to info@interimprograms.com thank you!
Your application is complete once we receive your interests and photo and we look forward to speaking with you soon.
A copy of your responses will be emailed to the address you provided.
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