Application for Host Family Accommodation
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Student Name (First, Middle, Last):
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Home Address:
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City
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Postal Code
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Country
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Phone (home):
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Phone (cell):
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Fax
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e-mail
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check-in:
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check-out:
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Do you smoke?
yes
no
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Do you have allergies?
yes
no
If yes, which?
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Families with children okay?
yes
no, I prefer a family without children
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Families with pets okay?
yes
no, I prefer a family without pets
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List your hobbies:
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Describe your expectations:
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Indicates Response Required