Today's Date

Name:

Address:

Email Occupation Age Bracket 20-30 31-40 41-50 51+

Phone: Home Cell Work

Gender: Female Male
Marital status:

Spouse/Partner's name (if applicable):

Spouse's occupation:

Spouse's phone: (work) (cell)

Age and gender of children:

Religion or church affiliation? (Optional)

What are your interests, hobbies or talents?

Do you or a family member smoke? Yes No
Do you object to hosting a smoker? Yes No

Do you have pets in the house? Yes No
If yes, what kind?

In which foreign countries have you lived or traveled?

What languages do you speak in addition to English?

Please list the top three countries that interest you:

Will you accept a student from another country if none are available from those you listed? Yes No

What level of a student's conversational English are you willing to accept? Very Limited Adequate Fluent No Preference

Please select your friend preference:

Students are here for varying amounts of time. Please indicate your preferred time commitment: One Semester One Year More than One Year No Preference

Are you new to the program? Yes No

How did you hear about the international Friends program?

Please check any other activity associated with the International Friends program that interests you.
Become a Home-stay Family for 3-5 nights for newly arriving students. January August Either
Assist with luncheons, receptions, and/or Welcome Picnics.
Provide interested students with information about your business or profession
Name and type of business

If you have any questions, call 970-484-5954 or 970-206-4824.