Test
Applicant Last Name Applicant Name Spouse's Name
Home Address City State Zip Code
Home Phone Cell Phone Spouse's Cell Phone Email Spouse's Email
   Appliant: Occupation  Employer  DOB 
   Spouse: Occupation  Employer  DOB 
PROVIDE THE FOLLOWING INFORMATION FOR OTHER FAMILY MEMBERS OR OTHER PERSONS LIVING IN YOUR HOME:
Adult 1 Adult 2
Name:
Email:
Gender:
DOB:
Relationship:
Name:
Email:
Gender:
DOB:
Relationship:
Child 1 Child 2 Child 3
Name:
Gender:
DOB:
School:
Name:
Gender:
DOB:
School:
Name:
Gender:
DOB:
School:
  PROVIDE THE FOLLOWING INFORMATION FOR PETS YOU HAVE IN YOUR HOME:
Dog(s): Number: Breeds(s): Kept:
Cat(s): Number: Breeds(s): Kept:
Other Pet(s): Number: Types(s): Kept:

  PROVIDE THE FOLLOWING INFORMATION ABOUT YOUR HOUSEHOLD:
Please Select:       House       Apartment       Condo

How many students can you accommodate?       1       2       3

I/We prefer:       male student       female student       no preference

Are there smokers in your household:       Yes       No

How often do you go out to eat during the week?       1-2 Times       3-4 Times       5 or more Times
  PROVIDE THE FOLLOWING INFORMATION YOUR FAMILY ACTIVITIES AND INTERESTS:
Rate your family's activity level:

Check each of the activities below that you or your children currently engage in::
  PLEASE DESCRIBE WHY YOU WOULD LIKE TO BE A HOST FAMILY
  HOST FAMILY SCHOOLS
Check each of the schools below that you would be willing to provide homestay: