Host Name(s):
Last name:
First name:
Gender : Male Female

Occupation (if retired, previous occupation):

Work Phone:

Last name:
First name:
Gender : Male Female

Occupation (if retired, previous occupation):

Work phone:
Home address:
Street:
City/State:
Zip:
Email:
Home phone:

Children:
Boys' names and ages:
Girls' names and ages:

Affiliations and Interests:
Community Affiliations (Church, Civic Groups, etc.):

Hobbies or Family Interests:


Host History:
Have you hosted students before? Yes No        
If Yes, list which years:

Are you willing to host two students for the academic year?
Yes No Call me first to verify

Are you interested in serving on the International Friendship Program Committee which helps to administer the program (matching, host recruitment, social functions)?
Yes No

Student Preference:
We try to accomodate your preferences, but because a student profile may not match your request, it is not always possible.

Undergraduate Graduate No Preference

Single Male Single Female Married with children
Married without children No Preference

Are you willing to take a student who does not meet your preferences? Yes No

Comments:
How did you hear about the International Friendship Program?


Additional Comments: