Village Program – Application Form
If you would like to participate in our Village program, please fill out the application form.

The signed waiver & $500.00 deposit must be sent to:
Director of Programs
Passage International
GPO Box 8974
CPC 373
Kathmandu, Nepal
Once an applicant has been approved, we will send out health forms, equipment lists, air travel instructions and further information about the trip.
Checklist: Your application will not be considered complete without the following
  1. Application
  2. Health Form
  3. Waiver
  4. Deposit of $500 by wire transfer to:
    Account Number 5897900
    Account Name Passage International
    Bank Name Nepal Investment Bank Ltd.
    Swift Code NIBLNPKT
    Bank Address Durbar Marg, Kathmandu, Nepal
I am applying for Village Program, Year:

Please fill in all the fields.
Your Personal Information
Date of Birth:
Passport #:
State where issued:
Date of issue:
Date of expiration:
Your email address:
Your current address:
Parents' names:
Parents' email:
Parents' address:
Parents' phone:
Emergency contact number:
Please give us the name(s) and age(s) of your sibling(s):

Please give us the name of a reference for you at your school (such as your guidance counselor):

School's name:
School's contact:
Relationship to student:
Contact's email/telephone:
School address:
Please tell us about yourself, your education, your interests and your family.
Why do you want to participate in a Passage program and what do you plan to do when it is over?
Have you ever traveled abroad? If so, where and what were your experiences?
What is your greatest concern about participation in Passage International?
What aspect of the program most/least interests you?
most = *****     least = *
Cross-cultural experience (home stay)
Language learning
Individual exploration
Independent Study Projects
Independent Study Projects - Options
The Arts
Guitar (Dramyen)
Jewelry making

Esoteric Studies


Development & Service
Teach English
Educating on Hygiene and Sanitation
Do you have any preferences to the type of family you would like to live with? Take into consideration your needs for privacy and modern comforts.
How did you hear about Passage International?
If you found out about our programs from our website, where did you link to us from?
What other programs, if any, were you considering?
I am enclosing my application fee of $500 (made payable to "Passage International").
Full Name: Date:
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