Winter Break Host Family Application

Please don't fill out this input box.

Family Information

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First Name*

Last Name*

Address*

Personal Email*

Cell Phone

Marital Status*

Single

Married

List names and ages in immediate family who live with you and their relationship to you.*

General Information

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How did you hear about us?*

Trine Website

Trine Faculty/Staff

Friends/Family

Social Media

Church

Other

What is your field of occupation?*

Please list hobbies and things you and your family are interested in:*

Please share why you are interested in hosting an exchange student.*

Would you be able to drop off and pick up your student from Trine before and after their classes?*

Yes

No

Would you be able to take your student on an excursion during Labor Day Weekend?*

Yes

No

What other activities do you envision for the two weeks you are hosting this student?*

Personal Information and Preferences

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Do you smoke?*

Yes

No

Do you have any pets? If so, please list:*

What do you hope to get from the Short Term Host Family Program?*

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