International Friends Family Interest Form

1. Family Information:

Primary Contact (Name)*

Spouse (if applicable)

Age Range*

Under 30

30 - 45

45 - 60

60+

Permanent Address*

City

State

Zip Code

Email Address*

Cell Phone Number

Home Number

Children Living at Home

Child's Name

Gender

Female

Male

Age

Child's Name

Gender

Female

Male

Age

Child's Name

Gender

Female

Male

Age

Child's Name

Gender

Female

Male

Age

2. Other Family Information

Please list your family's primary interests, activities, and hobbies (arts, sports, music, etc.)

Please indicate if your family has animals

Cats

Dogs

Other

If other please specify

Someone in my family smokes

Yes

No

Smoking occurs

Indoors

Outdoors only

Other family information

3. Preferences

We will to do out best to pair you with a student who matches your preferences. However depending upon the applications we receive, we may not be able to match you perfectly. If any of these preferences are critical for your participation in International Friends, please indicate so.

My family willing to accept a

Female

Male

My family minds if a student smokes

Yes

No

We would be willing to accept a second student if there is a shortage of families

Yes

No

Why do you wish to participate in International Friends?

Additional Comments

4. Family History

Have family members traveled or lived abroad? If so, please list which family members and where

Please indicate the foreign language background of any family members

Religious background or affiliation (optional)

Does a family member have a criminal record? If so explain below

How did you find out about International Friends?

Please note that International Friends is a program intended to encourage diversity and offer cross-cultural learning opportunities. It is vital for everyone involved to have an attitude of respect for individuals who come from diverse cultural, political, and religious backgrounds.

*

I Agree