TAKING OFF

Questionnaire

The purpose of the questionnaire is to help you focus on areas that you need to consider as you explore the idea of taking off. Since most people have never seriously asked themselves what they would do if they had time off, the answers may not be as easy as you think especially when you have limited information about of the possibilities. In the process of planning your time off we help you explore the possibilities so that you can clarify what is important and define the parameters that will determine where, when and how you spend your time. For the purpose of this questionnaire try not to limit your horizons. Use the multiple choice and short (very short) essay type questions as your guide. Think about things you have done as well as things you would like to do. Please add anything you feel is pertinent on the back of this form or another piece of paper. Remember, there are no right or wrong answers; this is not a test.


Please check the desired item(s), type in the necessary information, and press the SUBMIT button at the bottom.

First Name:   Last Name:
Home address 1: Fax:
Home address 2: E-Mail address:
Home phone: Cell phone:
City: Zip code:
U.S. State: Country:
Address if you are not at home:
High School: Graduation year:
Dual citizenship? NO YES      If yes, indicate second country:
Parent's names:
Parent's address (if different than above):
Mother's occupation: Work phone:
Father's occupation: Work phone:
List your siblings and their age:
Your age:    Date of Birth (mm/dd/yr):
 
Where do you want to go?
Separate your choices with commas.
 
Alaska
Asia Europe South America Worldwide
  Hawaii Thailand England Latin American Ocean
  The Pacific India Ireland Central American Antarctica
  Bali/Fiji Vietnam Scotland Peru Caribbean
  Philippines China Wales Amazon Mediterranean
  USA Nepal France Brazil Canada
  Northeast Africa Spain Mexico French speaking
  Southeast Australia Italy Belize Spanish speaking
  Midwest New Zealand Greece Costa Rica Israel
  Northwest Mideast Germany Ecuador Cuba
  Southwest Eastern Europe  
 
What type of lifestyle would you prefer?
Use categories below to describe the lifestyle that best suits your needs. Add other categories or descriptive words that are important to you. Separate your choices with commas.
             
academic rural wilderness travel learn a language need a hot shower
  nonacademic urban adventure on your own be part of a group roughing it
  outdoors indoors ocean with people your age with Americans home stay
  dormitory office cultural immersion college credit physical labor live in one place
 

What do you want to do?
Use the keywords below to describe the things you would like to do. Add other descriptive words that are important to you. Separate your choices with commas.
 
animals anthropology archaeology architecture art History big game boat building botany
  Buddhism business ceramics chemistry children computers construction cooking
  creative writing dance dolphins drawing engineering environment farming film
  finance fresco painting gardening government guitar making health care hiking historical restoration
  history horses hotels jewelry journalism languages law marine biology
  martial arts media museums music painting photography politics publishing
  rain forest sailing science scuba diving sculpture social Justice social service special needs
  spiritual sports teaching theater tourism vet. medicine whales wildlife
  women's issues yoga            
 

How do you plan to spend your time off? How many different experiences do you hope to have?

When do you want to leave and for how long?

Please describe your previous travel experience:

Please describe your language experiences. (What have you studied, for how long, future interests.)

Please describe your current academic status. Are you enrolled in college or university?
If so, where and what year. Do you plan to return?
How did you find out about Taking Off?
Do you have a budget?

Please indicate your strengths:

What gets in your way?

Please enter any additional comments or questions:

 

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