HOST FAMILY PROGRAM STUDENT APPLICATION
First Name
Last Name
Nickname
Home Address-Street
Home Address-City
Home Address-State
Home Address-Zip
Home Telephone 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)
Date of Birth (mm/dd/yyyy)
Gender
If you are new to Fort Lewis College, what type of student are you?
If not already on campus, what is your expected date of arrival? (mm/dd/yyyy)
Please describe your academic interests
What do you do for fun?
If you have any food restrictions, please list
If you have a problem with family pets, please describe
Do you smoke?
What languages, other than English, do you speak?
Would you like to have another student (perhaps a friend) matched with the same Host Family?
If you have a particular student in mind, what is that student's name?
If available, would you like to stay in Durango during Thanksgiving week and/or Spring Break, when residence halls are closed?
Do you have any other special needs or concerns regarding Host Family placement?
What would you most like your Host Family to do for you?
Are you an international student?
If you are an international student, what is your country of citizenship?
If you are an international student, have you been to the US before?
If you are an international student, have you studied in the US before?
Thank you for your interest in the Host Family Program. Your answers will be shared with the Host Family assigned to you.
FORT LEWIS COLLEGE      1000 RIM DRIVE DURANGO, COLORADO 81301      (877)FLC-COLO(TOLL FREE)      ADMISSION@FORTLEWIS.EDU