Primary Host Student
Tell us a little about yourself
Name (Full)
First Name
*
名姓
Last Name (Family Name)
*
姓
Tour Code
Gender
*
Male 男
Female 女
Non-binary/Other ノンバイナリー／その他
Prefer not to say 回答しない
Age
*
年齢
Grade
*
9
10
11
12
N/A
Address
*
Street Address 住所
Street Address Line 2 住所
City 市
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code 〒
Home Phone 電話番号
*
Cell Phone 携帯電話
*
E-mail
*
Confirmation Email
example@example.com
Which week works best for your family to host?
Week 1 (January 30 - February 6)
Week 2 (February 6 - February 13)
Either Week
Family Information 家族構成
Please list details for all family members at home
Parent 1
*
First
Last
Relationship
*
続柄
Age
年齢
Cell Phone 携帯電話
*
Parent 1 Email
*
example@example.com
Family 2
First
Last
Relationship
続柄
Age
年齢
Cell Phone 携帯電話
Family 2 Email
example@example.com
Family 3
First
Last
Relationship
続柄
Age
年齢
Family 4
First
Last
Relationship
続柄
Age
年齢
Family 5
First
Last
Relationship
続柄
Age
年齢
More about you and your family
Host Student's Interests
*
ホスト生徒の趣味
Family's Interests
*
家族の趣味
Family's Likes
*
家族の好きなこと
Family's Dislikes
*
家族の嫌いなこと
Pets
*
ペット
Any house rules the student should know?
家族の決まり事はありますか？
Additional information you would like the student to know
その他で生徒が興味を示すような事等ありましたらご記入下さい
Please upload a current picture of you.
*
Upload a File
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