Student Compatibility Form

Covered & Connected

Student Compatibility Form

Help us find the best match. There are no right or wrong answers — just be yourself!
SECTION 1 - ABOUT YOU

1. Family name & contact information
Your name & contact information

First NameLast Name
PHONE NUMBER
Format: (000) 000-0000.
EMAIL ADDRESS
example@example.com
YEAR IN SCHOOL (FRESHMAN / SOPHOMORE / ETC.)
MAJOR / AREA OF STUDY
2. Where is your hometown? How far are you from home?
3. Best way to reach you
SECTION 2 - INTERESTS & LIFESTYLE
4. What are your interests and hobbies? (check all that apply)

Other
5. Any dietary preferences or restrictions?
5a. List any dietary preferences or restrictions
6. How would you describe your personality? (check all that apply)
7. Do you speak any languages other than English?
7a. Please let us know what other languages you speak
SECTION 3 - AVAILABILITY
How often would you like to meet with your family?
9. What times generally work best for you?
SECTION 4 - FAITH & WHAT YOU'RE LOOKING FOR
10. Where are you in your faith journey? What does your spiritual life look like right now?
11. What are you most hoping to experience through this program?
Anything else you'd like the coordinator to know?
MY COMMITMENT
"I am open to building a genuine relationship with my adopted family this year — staying connected, showing up, and letting them be a part of my life here in Rochester."
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: