Au Pair Program Extension Request Form
Request an extension for your current au pair program by completing all sections below. Ensure details are accurate to support your application.
Full Name of Au Pair
*
First Name
Last Name
Host Family Name
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Current Program End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Extension Duration
*
Please Select
1 month
3 months
6 months
Other
Reason for Extension Request
*
Host Family's Approval
*
Approved
Pending
Not Approved
Confirmation of Continued Eligibility (e.g., no major changes in status, agreement to program terms)
*
I confirm I continue to meet all program eligibility requirements
Upload Supporting Documentation (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional Comments or Information
Submit Extension Request
Should be Empty: