Penpal Intake Form (US) Section 1: Child InformationFull NameAgeGenderMaleFemalePrefer not to sayGrade/School YearSection 2: Where To Send LettersPlease use the school or facility address vs. home address. This enables mailing multiple letters in a bulk shipment.Mailing AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint HelenaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. MartinSt. Pierre & MiquelonSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Virgin IslandsUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweEmail AddressPhoneSection 3: Language ProficiencyPrimary LanguageProficiency in EnglishBeginnerIntermediateAdvancedFluentSection 4: Hobbies and InterestsHobbies/InterestsFavourite Subjects in SchoolExtracurricular ActivitiesSection 5: Personality and PreferencesAbout YouSection 6: Cultural BackgroundCultural Practices/Traditions/Holidays CelebratedSection 7: Photo UploadUpload PhotoChoose FileNo file chosenDelete uploaded fileEncouraged, but optional to load a photo of the Penpal. Photo and summary of interests will be shared w/matched Penpal to aid in letter writing.Section 8: Kusoma Literacy Bags SponsorshipIn addition to exchanging letters, learners in the U.S. will sponsor Kusoma Bags (literacy bags) for their Kenyan counterparts to enhance access to reading materials. These bags, designed to kick-start home libraries, include locally authored storybooks, a pen, a notebook and a reading tracker for personalized learning. By providing these resources, the program empowers Kenyan learners to develop their literacy skills and unlock growth opportunities. Click here to sponsor Kusoma BagUnable to Sponsor, need grant supportSection 9: Parental/Guardian ConsentParent/Guardian Full NameRelationship to ChildEmail AddressPhoneHow did you hear about us?Section 10: Consent and AgreementConsent1. I, the undersigned, as the parent/guardian of the above-named child, hereby give consent for my child to participate in the penpal program.2. I understand that this program involves exchanging personal information and communicating with another child from a different cultural background.3. I acknowledge that Amsha Africa Foundation facilitating this program will take reasonable measures to ensure the safety and privacy of all participants.4. I agree to hold harmless and indemnify Amsha Africa Foundation, its employees, and volunteers from any liability, claims, damages, or actions arising from my child’s participation in this program.5. I agree to commit to at least 1 year of communications with the matched penpal.6. I have read the important notice of prohibited items: Important Notice: Solicitation of Money or Gifts Prohibited in Dear Friend Pen Pal Program. We kindly remind all participants that Dear Friend strictly prohibits the solicitation of money or gifts within the program. The primary focus of this initiative is to foster genuine connections through the power of written communication. Additionally, we encourage pen pals to refrain from exchanging material gifts or money. Instead, we invite children to express their thoughts, share experiences, and explore cultural exchange through their heartfelt letters. Supervising adults play a crucial role in the Dear Friend Pen Pal Program. We kindly request that they carefully monitor the contents of the letters exchanged between pen pals. This ensures a safe and positive experience for all participants, nurturing a supportive and enriching environment. Thank you for your cooperation in upholding the values of Dear Friend and prioritizing the meaningful exchange of thoughts and ideas among pen pals.Yes, I agree with the above terms and conditionsOnce you submit the form details, we will get back to you within a few weeks to start your penpal friendship!Submit