HOST FAMILY PROGRAM--STUDENT APPLICATION
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* First Name: |
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* Last Name: |
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* Nickname: |
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* Home Address-Street: |
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* Home Address-City: |
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* Home Address-State: |
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* Home Address-Zip: |
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* Cell Phone Number: |
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* Email Address: |
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Summer Address-Street (if different from above): |
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Summer Address-City (if different from above): |
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Summer Address-State (if different from above): |
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Summer Address-Zip (if different from above): |
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* Date of Birth (mm/dd/yyyy): |
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* Gender: |
Male
Female
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If you are new to Fort Lewis College, what type of student are you? |
First Year Freshman
Transfer
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If not already on campus, what is your expected date of arrival? (mm/dd/yyyy) |
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* Please describe your academic interests: |
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* What do you do for fun? |
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If you have any food restrictions, please list: |
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If you have a problem with family pets, please describe: |
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* Do you smoke? |
Yes
No
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* What languages, other than English, do you speak? |
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* Would you like to have another student (perhaps a friend) matched with the same Host Family? |
Yes
No
Don't Care
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If you have a particular student in mind, what is that student's name? |
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* If available, would you like to stay in Durango during Thanksgiving week and/or Spring Break, when residence halls are closed? |
Yes
No
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Do you have any other special needs or concerns regarding Host Family placement? |
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* What would you most like your Host Family to do for you? |
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* Are you an international student? |
Yes
No
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If you are an international student, what is your country of citizenship? |
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If you are an international student, have you been to the US before? |
Yes
No
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If you are an international student, have you studied in the US before? |
Yes
No
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