HOST FAMILY PROGRAM FAMILY APPLICATION
First Name
Last Name
Home Address-Street
Home Address-City
Home Address-State
Home Address-Zip
Home Phone Number
Work Phone Number
Cell Phone Number
Email Address
Summer Address-Street (if different from above)
Summer Address-City (if different from above)
Summer Address-State (if different from above)
Summer Address-Zip (if different from above)
Summer Home Phone (if different from above)
What are your interests?
Please list your occupation(s)
Number of family members
Ages of children
Your preferred student would be what gender?
Your preferred student would share what kind of cultural background?
Your preferred student would share what kinds of hobbies?
Do you have any pets?
If you have any pets, please list
Do you smoke?
What languages, other than English, do you speak?
Would you be willing to host more than one student? (Willingness to do this is not a requirement to serve as a Host Family.)
Would you be willing to have your student(s) stay with you during Thanksgiving week and/or Spring Break, when residence halls are closed? (Willingness to do this is not a requirement to serve as a Host Family.)
Why are you interested in the Host Family Program?
FORT LEWIS COLLEGE      1000 RIM DRIVE DURANGO, COLORADO 81301      (877)FLC-COLO(TOLL FREE)      ADMISSION@FORTLEWIS.EDU