Host ID:

Password:

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Host Information

First Name

Last Name

Host Sex

--- Select One --- Female Male

DOB

/ / Format: MM/DD/YYYY

Home Address 1

Home City

Home State

Home Postal Code

Current Address Duration

Home Phone

( ) -

Fax

( ) -

Mobile

( ) -

WorkPhone

( ) -

Email

Home Description

Other People Living There

Company Name

Occupation

Referred By

Has Hosted Foreign Student

--- Select One --- No Yes

Length Hosted Foreign Student

Host Foreign Languages

Host Special Interests

Do you smoke?

--- Select One --- No Yes

Spouse Information

Spouse First Name

Spouse Last Name

Spouse Sex

--- Select One --- Female Male

Spouse DOB

/ / Format: MM/DD/YYYY

Spouse Occupation

Spouse Company Name

Spouse Work Phone

( ) -

Matching Information

Allow Student to Smoke?

--- Select One --- No Yes Outside

Meal Plan Option Code

You can choose which meal service (if any) you would like to provide to students. Please pick from the following:

Room only: Student will be responsible for his or her own meals and you will not be responsibe to offer any foods or prepare any meals.

Breakfast only: You are asked to only to have breakfast foods available to students each morning; you need not fix the breakfast for them, but only have the foods available to them)

Room with Meals: This option includes the continental breakfast and a second meal of the day (usually dinner) which you will prepare for the students.

--- Select One --- Room and Breakfast Room Only Room with Meals

What Student Gender do you prefer?

--- Select One --- Both Female Male

Couple Code

--- Select One --- Couple Single

Occupancy Code

Please choose from the following options:

Double 1 Bed: You have a bedroom that can accommodate 2 students who request to share a bed (ex: two sisters attending same school)

Double 2 Bed: You have a bedroom that has two beds available for 2 students who request to share one room but with separate beds.

Single: You have a bedroom that can accommodate one student.

--- Select One --- Double 1 Bed Double 2 Bed Single

Will you provide a Private Bathroom?

--- Select One --- No Yes

Do you have Children?

--- Select One --- No Yes

Do you have Pets?

--- Select One --- Cat Only Dog Only No Yes

Will you provide Internet Access?

--- Select One --- No Yes