All fields required for submission. Please use N/A for not applicable

Name*

First Last

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell Phone*

Email*

Summer Address*

Summer Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth*

Gender*

If you are not already on campus, what is your expected arrival date?*

What are your academic interests?*

What is your major?*

What do you do for fun?*

If you have any food restrictions/allergies, please list:*

If you have a problem with family pets, please describe:*

Do you prefer a smoke-free environment?*

What languages other than English do you speak?*

Would you like another student matched with the same host family?*

Do you have any special needs or concerns regarding Host Family placement?*

What would you most like your Host Family to do for you?*

If you are an international student, what is your country of citizenship?*

If you are an international student, have you been to the US before? If so, where?*

If you are an international student, have you studied in the US before? If so, where?*

Phone

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