Thank you for participating in the FLEX competition!

FLEX is a US-Government-sponsored exchange program that allows students from Moldova to spend one academic year in the United States, living with a host family and studying in American high school. More information about the program is available on our website.

In 2012 only students of the 9th, 10th and 11th grades, born after 1 January 1996 and before 15 July 1998, are eligible for FLEX.

Students with disabilities who are currently studying in the 8th, 9th, 10th, 11th or 12th grade and were born between 15 March 1995 and 15 July 1998 are encouraged to apply.

To register for the Round One of the competition in 2012, applicants should complete the form below and show up on time at the selected location with required documents.

Guidelines on how to complete the form correctly are accessible here.

2012-2013 FLEX Registration Form

Last name:	(Ex.: Chetraru)
First name:	(Ex.: Ion)
Patronymic:	(Ex.: Vasile)
Gender:	Male Female
DATE OF BIRTH:
Month of birth:
Day of birth:
Year of birth:
E-Mail:	(Ex.: v2012@mail.md)
City/Town/Village, Raion:	(Ex.: Briceni, Donduseni)
Home Address:	(Ex.: str. Asachi 1, ap. 4)
School:	(Ex.: Liceul teoretic "Mihai Eminescu")
School Location: (city/town/village, raion)	(Ex.: Donduseni, Donduseni)
Class:
HOME TELEPHONE:
Number:	(xxx-xxxxx) please include regional code first
Mobile Telephone number:
Whose mobile phone is this?
How did you hear about FLEX?	FriendInternetLetterNewspaperPosterPresentationRadioRelativeTeacherTV
Select 2012 FLEX Testing Location:
Please type the code below: