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Host Family Connection Program - Student Application
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International Student Services
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Submitted by mmende on Thu, 02/10/2011 - 1:37pm
in
International Student Services
Name:
*
Campus Address:
*
CMR:
*
Email:
*
Phone:
*
Cell Phone:
Citizenship:
*
Country in which you live:
Birth Date:
month/date/year
Gender:
*
Male
Female
Intended field of study:
First time in the US?:
Yes
No
What countries have you visited or lived in?:
What languages do you speak?:
Do you have relatives living in the USA? Who? Where?:
Indicate 4-5 activities that best represent your family's hobbies, skills and interests:
Biking
Bowling
Cooking
Faith Based Activities
Fishing
Gardening
Golfing
Musical Activities
Movies
shopping
Technology
Sports Events
Hiking
Volunteering
Museums
Theatre/Acting
Other experiences or interests:
Please share any other experiences or interests that might help us get to know you better, so that we can match you with an appropriate host:
Indicate any preferences with respect to the following
Children:
*
With Children
Without Children
No Preference
Pets:
*
With Pets
Without Pets
No Preference
Are you allergic to any pets? If so, please specify:
*
Are you open to being matched with a "nontraditional" family or household?:
*
Yes
No
How much time do you anticipate spending with your new host family?:
*
Weekly
Every Other Week
Monthly
2-3 Times a Year
Would you prefer that your host have a specific religious affiliation?:
*
Yes
No
If yes, which religious affiliation would you prefer?:
Do you smoke?:
*
Yes
No
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