Life Adventures Check In

Monthly Check In Form

"*" indicates required fields

Comments

This field is for validation purposes and should be left unchanged.

Full Name*

As on your DHS form

First Last

Sevis Number*

# on your DS form

Do you have your Medical Insurance card?*

Yes

Employer's Name*

Please input the name of the location where you work and not your supervisor name.

Are you happy with your current employer?*

Yes

If you are NOT happy with your current employer please explain why.

Housing Address*

Street Address Address Line 2 City State ZIP Code

Are you happy with your current housing?*

Yes

Are you working a second job?*

Yes

What is the name of the second job?

Please list the cultural activities you have done:*

Can be anything about experiencing something in American culture

Do you have any questions / concerns you would like Life Adventures to contact you about?*

If YES you want to be contacted by Life Adventures, what is your US Phone Number or WhatsApp Phone Number:

Expected Departure Date*

Please be as accurate as possible as this will be used to update insurance information, program dates, etc. if necessary.

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