Department for Educational Research and Design
Office of International Student Exchanges
Amy Flynn, Director
1829 Denver West Drive, Building 27
Golden, Colorado, 80401
Phone: 303-982-8939
Fax: 303-982-6993
Email:aflynn@jeffco.k12.co.us
24 September, 2015
Dear International Student Exchange Agency Leaders and Representatives:
We’re nearing the time of the year when our partner exchange agencies complete the annual application for approval to
place international exchange students in Jefferson County for the next school year. As you know, all interested agencies,
including those currently approved, must apply on an annual basis. The application process includes a requirement to
attend our annual agency informational meeting. All agencies who wish to maintain their status on Jeffco’s approved
list and to place international exchange students in Jefferson County schools for the 2016-17 school year must have a
local, metro Denver area based representative at this meeting.
This meeting will be held:
Friday, December 4, 2015, 10:00 a.m. - 11:30 a.m.
Jeffco Ed Center
1829 Denver West Drive, Bldg. 27, Room 2A, Golden, CO 80401
(I-70 to Denver West Blvd., west across I-70 onto Denver West Marriott Blvd. – turn left onto Denver West Parkway, turn
left at four-way stop onto Denver West Drive. The building 27 entrance faces I-70.)
Please RSVP to me by Friday, November 20, 2015 with the name of your agency and the number of representatives who
will attend.
During the meeting, we will review the Jefferson County School District exchange program policies which are being
updated this year (therefore the previous policy is not included in this application packet), the agency application
process, and important deadlines. There will also be time for a question and answer session.
December 4th is also the deadline for agencies to complete and submit the following three documents. All of these forms
are included with this letter.
1. Agency Application (Please be sure to include all explanatory program material or samples requested in the
application.)
2. Contact Information Form
3. Affirmation of Agreement (To be filled out by each person who will be working with Jeffco to place
students.)
Please send all of the above items to me at the address above via U.S. mail, email or fax, or your local representative can
bring them to the December 4th meeting.
I look forward to working with you in my role as the liaison between Jefferson County Public Schools and our partner
exchange agencies. In the meantime, please don't hesitate to contact me if you have any questions.
Best regards,
Amy Flynn, M.A.
Director of International Student Exchanges
JEFFERSON COUNTY INTERNATIONAL STUDENT EXCHANGE
AGENCY APPLICATION FOR APPROVAL
AGENCY NAME:____________________________
SCHOOL YEAR: 2016-2017
Exchange – visitor (J-1) Agency Request to Place International Exchange Students
ORGANIZATION: Update
1.
How long has this program operated in Colorado?
____________________
References: Please provide the names, addresses and phone numbers of three persons who have had
direct contact with your organization during the last year. The references should include a school
administrator and a host family and may not include persons directly associated with the organization.
__________________________
Name
__________________________
Host Family
__________________________
Administrator
_______________________________
Address
____________________
Phone Number
_______________________________
Address
____________________
Email
____________________
Phone Number
_______________________________
Address
____________________
Email
____________________
Phone Number
____________________
Email
2.
How many students from other countries have participated in this organization’s inbound student
exchange programs in the last three years?
_________
How many of these students have come to Colorado schools?
_________
3.
How many students from other countries have participated in this organization’s outbound student
exchange programs in the last three years?
_________
How many of these students were Colorado students?
_________
Inbound Students
4.
In total, how many Jefferson County families contacted your organization during the last year about
hosting an inbound student?
_________
5.
Of these, how many actually hosted a student for the duration of the program?
Full year_______________
One semester____________
6.
How does your program assess and monitor English language proficiency?
What criteria does your program apply to determine a student's capability to function over time in the
regular educational program? How does your organization handle the situation where a student is
unable to function in the regular academic program because his/her English is found to be insufficient?
7.
Has your organization made any changes to its orientation/training program for local representatives in
the past year? If so, what changes have been made?
OUTBOUND STUDENTS
8.
9.
In total, how many Jefferson County families contacted your organization during the last year about
outbound opportunities
_________
Of these, how many actually participated in an outbound program?
Full year____________ One semester____________ Other____________
10. Has your organization made any changes to its outbound recruitment practices in the past year? If so,
what changes have been made? Please submit a copy of your most recent outbound recruitment flyer or
handout.
Program Costs Update
11. What are the current itemized and total program costs in American dollars for an inbound exchange
student sponsored by this program? (e.g., travel, insurance, program fees, etc.)
TOTAL
Item
____________________________
Cost
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
12. What are the current itemized and total program costs in American dollars for an outbound Jefferson
County Schools student sponsored by this program? (e.g., travel, insurance, program fees, etc.)
TOTAL
Item
____________________________
Cost
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
13. What is the current cost of this program to a Jefferson County host family?
14. Does a Jefferson County host family receive a stipend for hosting an inbound student?
PROGRAM PROJECTIONS
If this program is approved by Jefferson County Public Schools for the next school year…
15. How many inbound students would you like to enroll, and in which schools would you like to place
them? (Jefferson County places international exchange students on a space available basis in the
district’s regular public and charter high schools only. We do not place students in other school districts
or in any private or parochial schools.)
16. How many outbound Jefferson County Schools' students could be accommodated by this program?
Agency Application for Renewal, Revised 9/2015
This document replaces earlier versions.
JEFFERSON COUNTY INTERNATIONAL STUDENT EXCHANGE
AGENCY REPRESENTATIVES CONTACT INFORMATION
SCHOOL YEAR 2016-2017
Name of Organization: ______________________________________________________________
National Director: _________________________________________________________________
Street Address ____________________________________________________________________
City/State/Zip
____________________________________________________________________
Work Phone __________________________ Home/Cell Phone _____________________________
Email ____________________________________________________________________________
Area/Regional Coordinator: __________________________________________________________
Street Address ____________________________________________________________________
City/State/Zip
____________________________________________________________________
Work Phone __________________________ Home/Cell Phone _____________________________
Email ____________________________________________________________________________
Local Representative: _______________________________________________________________
Street Address ____________________________________________________________________
City/State/Zip
____________________________________________________________________
Work Phone __________________________ Home/Cell Phone _____________________________
Email ____________________________________________________________________________
Local Representative: _______________________________________________________________
Street Address ____________________________________________________________________
City/State/Zip
____________________________________________________________________
Work Phone __________________________ Home/Cell Phone _____________________________
Email ____________________________________________________________________________
Submitted by: _____________________________________________________________________
Date: ____________________________________________________________________________
---------------------------------------------------------------------------------------------------------------------------Submit this form to:
Amy Flynn, Director of International Student Exchanges
Jefferson County Public Schools
1829 Denver West Drive, Building 27, PO Box 4001, Golden, CO 80401
Fax: 303-982-6993
Phone: 303-982-8939
Email: aflynn@jeffco.k12.co.us
Agency Representatives Contact Info., Revised 9/2015
This document replaces earlier versions.
JEFFERSON COUNTY INTERNATIONAL STUDENT EXCHANGE
AGENCY REPRESENTATIVES’ AFFIRMATION AGREEMENT
SCHOOL YEAR 2016-2017
I, ___________________________________________________________, a Representative for
______________________________________________________ (Exchange Agency), AFFIRM:
that I will abide by the policy and regulations of the Jefferson County Schools' Board of Education
regarding the Admission of International Exchange Students;
that I will place international students in Jefferson County after acceptance by the district’s Exchange
Program Coordinator, not before; and,
that I will inform the district’s Exchange Program Coordinator of any changes in host families after
initial placement.
Representative's Name (Printed) _____________________________________________________
Street Address ___________________________________________________________________
City/State/Zip
___________________________________________________________________
Work Phone __________________________ Home/Cell Phone ____________________________
Email ___________________________________________________________________________
Signature ________________________________________________________________________
Date ____________________________________________________________________________
Submit this form to:
Amy Flynn, Director of International Student Exchanges
Jefferson County Public Schools
1829 Denver West Drive, Building #27
Golden, Colorado, 80401
Phone: 303-982-8939
Fax: 303-982-6993
Email: aflynn@jeffco.k12.co.us
Agency Representatives Affirmation, Revised 9/15
This document replaces earlier versions.