Host Family - Student application

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Student Information

First Name

Last Name

Date of Birth* (Fill in by DD/MM/YYYY. Example: 25/01/1991)

Address

Trine Email

Personal Email

Cell Phone

How often do you check your email:

Daily

Weekly

Monthly

Marital Status

Single

Married

Gender

Male

Female

Emergency Contact Information from home country(parent/guardian preferred)

Last (Family) Name*

First (Given) Name*

Relationship (example: mother, father, brother, etc)

Address

Home Telephone

Business Telephone

General Information

How did you hear about us?

Orientation

Trine Faculty/Staff

Friends/Family

Social Media (Facebook, etc.)

Trine Website

Other

Level of study

Short term program

ESL

Undergraduate

Graduate

Spouse

Major

Duration of Stay (approximate)

Short term program

One semester

One year

Two years

Three years

Four or more years

Country of birth

Country of citizenship

What is your visa category?

F-1 ESL student

F-1 Degree student

J-1 student

J-1 Scholar

B-visitor visa

Esta - visitor visa

Please mark your host family preference

Family

Married Couple - no children

Single Female

Single Male

No Preference

List hobbies and things you are interested in doing outside of campus

Why are you interested in the Host Family Program?

What do you feel you will get from this program? How will it benefit you and your host family?

Personal Information and Preferences

How would you rate your English skills?

Poor

Fair

Good

Excellent

Do you smoke?

Yes

No

Would you be okay to visit a home where members of the host family smoked?

Yes

No

Do you drink alcohol?

Yes

No

What is your health condition?

Excellent

Good

Fair

Poor, please explain below

If you marked poor in the question above, please explain

Are you currently on any kind of medication or have any health problems that your homestay family should be aware of?

Do you have any allergies?

Is there any type of food that you cannot eat due to dietary or religious reasons?

Are there any types of food that you do not like?

Are you allergic to any pets?

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