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Host Family Program Family Application
First Name:
*
Last Name:
*
Home Address-Street:
*
Home Address-City:
*
Home Address-State:
*
Home Address-Zip:
*
Home Phone:
*
Work Phone:
Cellular Phone:
Email Address:
*
Summer Address-Street:
Please provide summer address if different from above.
Summer Address-City:
Summer Address-State:
Summer Address-Zip:
Summer Home Phone:
What are your interests?:
*
Please list your occupation(s):
*
Number of family members:
*
Ages of children:
Your preferred student would be what gender:
*
Male
Female
No preference
Your preferred student would share what cultural background?:
Your preferred student would have what academic interests?:
Do you have any pets?:
*
Yes
No
If yes, what type of pet(s)?:
Do you smoke?:
*
Yes
No
What languages, other than English, do you speak?:
Would you be willing to host more than one student?:
*
Yes
No
Would you be willing to have your students stay with you over breaks?:
*
Yes
No
Why are you interested in the Host Family Program?:
*
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