(To be given to Host Family)
Date _____________________
Last Name_______________________________________________________________________
First Name____________________________________________________________ Sex (M or F)
Local Address____________________________________________________________________
________________________________________________________________________________
Telephone____________________________________Home Country________________________
Date of Birth___________________________________Religion___________________________
Married (Yes or No) If your spouse is in the U.S., what is his/her name?______________________
Major field of study________________________________________________________________
Languages spoken_________________________________________________________________
Hobbies or special interests__________________________________________________________
How long have you been in the United States? __________________________________________
How long will you be attending U.C.O.?_______________________________________________
Do you have a car? ________________________________________________________________
Would you like to be placed with a family that:
1) has no children________ 2) has children __________ Or, 3) no preference _____________
E-mail Address: _________________________________