| Host Student Information |
Have you ever been abroad? (where exactly)
What do you plan on doing in your free time when your guest is with
you?
List the languages that you and your parents speak?
Are all the persons living at home willing to speak English only while
the exchange student is visiting?
Yes No Will try
On average do you consider your foreign language skills
Basic Moderate knowledge Excellent
Please list
your interest and hobbies
School Attending
Grade
Date of Birth
|
Home Address:
City: State: Zip:
Home Phone Number
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| Parents in Household |
Mother's Cell
Phone Number:
Mother's Email
Address:
Mother's
Occupation / Title:
Mother's Place
of Employment:
Mother's Work
Phone Number: |
Father's Cell
Phone Number:
Father's Email
Address:
Father's
Occupation / Title:
Father's Place
of Employment:
Father's Work
Phone Number: |
| Please
list all additional people living in the house |
Name: age:
Name:
age:
Name:
age:
Name:
age:
Name:
age:
Name:
age: |
| Home
Environment |
Check if you
have pets:
If so what kind?
Check if anyone
in your home smokes: |
| Potential
Exchange Student |
Describe your
ideal exchange partner
Do you prefer a
male or female student:
Male Female Either
Will your guest
have his/her own bedroom?
Do you have the
resources and space in your home for an exchange student?
Check if you wouldlike your partner to attend religious services with you during his/her stay.
If you checked the above box, what religion do you practice?
|
| Traveling
Information |
Check if you
are planning on traveling while you will be hosting the student:
If so, Where
When (please give exact dates)
Check if the student will need to provide money for plane tickets
or entrance fees
If so, how much would you anticipate the student needing? $
Number where you can be reached during your trip
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|
Security Code (caps only):
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