Michigan State University

Friendship Family Program

Family Application
Today's Date
Person 1
Last Name: Gender: Male Female
First Name: Age: Young Middle Senior
Occupation:
Home Phone: Cell Phone:
Email: Work Phone:
Preferred method of contact: Best times to contact you
Person 2
Last Name:
First Name: Gender: Male Female
Occupation:
Home Phone: Cell Phone:
Email: Work Phone:
Preferred method of contact: Best times to contact you
Local Address
Street:
City: Zip Code:
Please list any children or additional members of your household
(Name, Age, Gender)
Please use a separate line for each member
About You
Community Affiliations
Church Affiliations
Interests/Hobbies
Do you smoke? Yes No
Do you have pets? Yes No If yes, what kind?
Languages you speak: Languages you are interested in:
Countries you have lived in: Countries you have visited:
Student Preferences
Preferred Country:
Male
Female
No Pref. 		Single
Married
No Pref. 		With Children
No Children
No Pref.
Area of Study: Pursuing degree:
Short program(under 2 years)
Long program(over 2 years)
Other Preferences
Personal Reference
Name: Relationship:
Email: Phone:

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