USAUPAIR AuPair Lead Form

Yes, I would like to learn more about being an Au Pair in the USA for one full year with USAuPair.
Your Name*

First NameLast Name
Your E-mail Address*
Your Phone Number:*

Country or Area CodePhone Number
Your Country of Residence:*
Your Citizenship:*
Your Age:*
Child Care Experience with children Under 2 years of age:*

Less than 200 HoursMore than 200 HoursNone
Child Care Experience with children Over 2 years of age:*

Less than 200 HoursMore than 200 HoursNone
Your English Language level is:*

ExcellentGoodFairPoor
Preferred Timeline for Placement by USAuPair:*

ImmediatelyIn the next 3 monthsAt some point in 2015Not Sure
Comments or Questions:
*Yes, Please contact me at the number I have provided regarding additional information about AuPair.com and USAuPair. We respect your privacy and will not sell your contact or personal information.

USAuPair is a trusted partner of AuPair.com and provides au pair and international education opportunities of the highest quality.
Should be Empty:

Yes, I would like to learn more about being an Au Pair in the USA for one full year with USAuPair.