Student Application

Basic Information
First Name
Family Name
American Nickname
What do you prefer to be called?
Gender
Age
Email
U.S. Information
Name of School
U.S. Address
City
State
U.S. Telephone
Cell phone
College Major
Career Goals
Home Information
Home Country
Home Address
Person to Contact in Case of Emergency
Name
Relationship to You
Phone Number
Personal Information
Date of Birth

MonthDayYearHourMinutesAM/PM Option
Languages you speak
Religion
How well do you speak English?
Favorite American foods
What are your interests/hobbies?
Tell us something about yourself
Host Family Preferences
(Check all that apply)
Would you enjoy staying with a host family that...
Some host families have pets or farm animals. Please check if you would NOT like to be with these animals
Do you have any health or diet restriction that your host family would need to know?
Should be Empty:

Basic Information