General Information
Family Name	*
We want to host	Boy Girl Both *                     Age:
	Father's Name
Name	*
Occupation	Work Phone Cell Phone
	Mother's Name
Name	*
Occupation	Work Phone Cell Phone
Home Address
City	State
Zip Code
Phone	Fax
E-mail	*
Religion
	Children
Name Age Gender School Boy Girl Boy Girl Boy Girl Boy Girl Boy Girl
Parish or church we attend
Languages spoken at home
Ethnicity	White Black Asian Hispanic Indian
Parents of the host student are	Married Divorced Other
	Host Child Information
Name	*
Gender	Boy Girl *
Age
Date of Birth	Day 12345678910111213141516171819202122232425262728293031 Month 123456789101112 Year 19901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 *
School
Grade
Religion
Email
Gets to School By	Bus Car Other
	Additional Information
Family interests and Hobbies
Recreational activities your Family participates in, and things you do on weekends or places you go to
Three descriptive characteristics Host Child's Personality
Extracurricular activities Host Child's Personality
Reasons why you would like to have an Exchange student in your home
Our son/daughter and our family; accepts hosting an exchange student for 8 weeks. We will treat him/her as a member of our family and make him/her feel at home and make him/her follow our same guidelines and schedules. We will provide accommodation, food and facilitate school attendance.