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Host Family Application
Student Info:
Student name
Coordinator
Community
Contact info:
Last name
Home phone
Address
City
State
Zipcode
Email
Fax
Parent Info:
Father's Name:
Father's Occupation:
Father's Phone:
Mother's Name:
Mother's Occupation:
Mother's Phone:
Children:
Name
Age
Gender
Choose One
Female
Male
Grade/Interests
Name
Age
Gender
Choose One
Female
Male
Grade/Interests
Name
Age
Gender
Choose One
Female
Male
Grade/Interests
Name
Age
Gender
Choose One
Female
Male
Grade/Interests
Living Arrangements::
Family pets
Does anyone in your family smoke? (Choose one)
Yes
No
Will student share a room (Choose one)
Yes
No
If yes, with whom?
Activities and Interests
Swimming
Museums
Theatre
Camping
Fishing
Shopping
Travel
Sports
Bicycling
Boating
Cooking
Concerts
Movies
Music
Computers
Aerobics
Other
Why do you want to host an exchange student
References:
Reference Name:
Reference Phone
Reference Name:
Reference Phone
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