Office for International Students and Scholars

Community
	Host Family
		Student Application
		Family Application
		Information Letter
	Speak English With Us
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HOST FAMILY PROGRAM

Family Information Form

I authorize the Community Connections Program to use the information below to match me with an appropriate student.
The OISS will never share or sell your information with any third-party entities.

Applicant First/Last Name:

Applicant Occupation:

Spouse/Significant Other First/Last Name:

Spouse/Significant Other Occupation:

Address:

City:

Zip Code:

E-Mail Address:

Phone Number:

Names & Ages of Children Living at Home:

Would you accept a student with dietary restrictions (no pork, no dairy, vegetarian, etc)?

Comments on Food Restrictions:

Do you or family members smoke?

Does smoking by others bother you?

Do you have any pets?

If so, what kind and how many?

What foreign language(s) do family members speak, if any?

Have family members traveled outside the USA?

If so, where?

Which would you prefer?

Would your student need to have his/her own transportation?

Comment?

Are you willing to have a student from any country?

If no, which country/language would you prefer?

Would you be willing to host more than one student?

Please indicate some of your interests. We will use this information to try and match you with a student with similar interests.

Arts and Crafts	Automobiles/Cars
Biking	Board Games
Computers/Electronics	Concerts
Cooking	Dance/Theatre
Hiking or Camping	Ice Skating
Photography	Picnics
Sightseeing	Skiing
Sports	Swimming/Boating
Other (Specify)

Do you have any additional comments, special interests, etc?

How did you hear about this program?

By submitting this application, I hereby grant permission to the OISS to print and reproduce photos taken at Community Connections events for promotional purposes.

Office for International Students and Scholars
Attn: Luisette Behmer
Campus Box 1083
One Brookings Drive
St. Louis, MO 63130
lbehmer@wustl.edu
FAX: 314-935-4075