Request Information to Become an Au Pair in the U.S.

Fill out the form below and we will provide you contact information for our partner office in your home country.  They will answer your questions and send you a brochure and application packet to get you started.

Note: There is always a great demand for au pairs who have more than 200 hours of experience caring for children under two years of age. If you have this experience caring for children who are not your family members, or can get this experience before applying for the program, you will receive a higher weekly stipend if placed with a family that has a child under two. You may also be placed faster and have more choices in matching with a host family.

First Name: *
Last Name: *
Email: *
Phone (with country and city codes)
Mobile Phone (with country and city codes)
Street Address Line 1:
City:
State, Province:
Postal Code:
Country: *	--Select One--AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaArubaAshmore And Cartier IslandsAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBassas Da IndiaBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, Democratic Republic Of Cook IslandsCoral Sea IslandsCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaEuropa IslandFalkland Islands (Islas Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern And Antarctic LandsGabonGambia, TheGaza StripGeorgiaGermanyGhanaGibraltarGlorioso IslandsGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle Of ManIsraelItalyJamaicaJan MayenJapanJerseyJordanJuan De Nova IslandKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMartiniqueMauritiusMayotteMexicoMicronesia, Federated States OfMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew ZealandNeutral ZoneNew CaledoniaNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalauPanamaParacel IslandsPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalQatarReunionRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre And MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia And The South Sandwich IslandsSouth KoreaSpainSpratly IslandsSri LankaStatelessSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTuvaluTurks And Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis And FutunaWest BankWestern SaharaYemenZambiaZimbabwe
Date of Birth: *	Month "---010203040506070809101112 Day ---01020304050607080910111213141516171819202122232425262728293031 Year "---19601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991
How did you hear about us? *	---Another WebsiteBook/MagazineCraigslistEmbassy/State Dept.Friend/Family/Past ParticipantGoogle/Yahoo SearchLocal Partner OfficePoster/BrochurePre-match with Host FamilyProfessor/Advisor/Campus EventReferred by U.S. Employer / CampTravel AgencyOther
Please explain. Name of book, online search words, website, where you saw a poster, name of professor/advisor, etc.
Please type in the Security Code shown below. Please type exactly as shown. ** Security Code