HOST FAMILY-SHARE OFFER APPLICATION

Dear prospective host,

If you would like to become a host family for a foreign students, please print this application form, fill out and fax it to us at (212) 564 0475. We will be contacting you by phone shortly thereafter to discuss your application and eventually make an appointment to see you.
You may also mail it to 53 West 36th. Street, Suite 802, New York, NY 10018.

Full Name: _____________________________________

Full Address: ________________________________________

Name of Neighborhood______________________________

Between cross streets of_____________________________

What kind of dwelling do you live in (Rental Apt. House, Coop, Condo, etc.)

How many bedrooms are available for students ______________

Telephone + Cell phone____________________________________

Fax ______________________________________________

E-mail ____________________________________________

Best time to contact you____________________________

What's your mother tongue ?__________________________

Do you speak other languages fluently? If so which languages: ___________________________________________________

FAMILY INFORMATION

You and Your Household

Did you ever host foreign students?   Yes   No

Please circle all items available for use of student:
    TV    Phone    Fridge    AC    Internet     Microwave    Private Bath
    Shared Bath    Bath

Would you permit guests to smoke inside your home?   Yes   No

How many children do you have?

How many live with you?

Please advise names, age & occupations:

Please tell us more about your household, hobbies and lifestyle.

Do you have any pets? If so, what kind and number:

Comments / Suggestions on the kind of student preferred (Male, Female, Nationality, etc.):