Host Family Student Application

05/20/2013
 
Personal Information
Name (first, middle initial, last): Nickname:
Native Country: Languages:
 
Do you smoke?     Yes   No
Does cigarette smoke bother you?     Yes   No
Do you have Allergies?     Yes   No
If Yes, please list.   
 
Contact Information
 
Colby Adddress:
Colby email:
 
Program Information
 
What are your interests? (These may include sports, music, games, art, travel, etc.)
 
What are your preferences? (List your like or dislike for children, animals, etc.)
 
We will do our best to match you with a host family according to your interests. Please use this space below to share any additional information. (Confidential)