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