Today's Date

Name:

Preferred name

Local Address:

Phone: Home Cell Work

Email

Date of Birth Place of Birth

Citizenship: Native Language:

Conversational English proficiency? Very Limited Adequate Fluent

What other languages do you speak?

Academic department at CSU:

Degree you are pursuing:

Purpose of your Stay:

Anticipated length of stay:

Marital status:

Spouse/Partner's name (if applicable):

Spouse's Language

Will you be accompanied by dependents? Yes No
Date of dependents' arrival:

Age and gender of children:

In which foreign countries have you lived or traveled?

Religion or church affiliation? (Optional)

Do you have any food restrictions or allergies?

Do you or a family member smoke? Yes No
Do you object to having a host who is a smoker? Yes No

Are you interested in sharing your experiences and talents in any of the following activities:

• Speaking about your country
• Singing
• Dancing
• Translating
• Playing a musical instrument, what kind?
• Other

How did you hear about the international Friends program?

We recommend a commitment of a school year unless you are participating in a shorter CSU program. We also suggest that you contact your community friend at least once a month.