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Fort Lewis College, Durango, CO

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Host Family Program Student Application

First Name:*

Last Name:*

Nickname:

Home Address-Street:*

Home Address-City:*

Home Address-State:*

Home Address-Zip:*

Home 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:

Date of Birth:*

Gender:*
Male
Female

If you are new to FLC, what student type are you?:
First year freshman
Transfer
Exchange for one term
Exchange for one year

If not already on campus, what is your expected arrival date?:

What are 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?:*
Yes
No

What languages, other than English, do you speak?:

Would you like to have another student matched with the same Host Family?:*
Yes
No
No preference

If you have a particular student in mind, what is his/her name?:

Do you have any 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?:*
Yes
No

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?:
Yes
No

If you are an international student, have you studied in the US before?:
Yes
No

Submit

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1000 RIM DRIVE
DURANGO, CO 81301
PH: (877) 352-2656
FAX (970) 247-7179
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