Host Home Application (for family)

Host Family Application

To facilitate a good match between interns and host families, please complete the following profile. This information, along with a profile completed by the intern will greatly assist us in matching compatible individuals and lifestyles.

Contact Information

Name

First Name

Last Name

Phone (preferred)

(###)-###-####

Phone (secondary)

Address

Address Line 1

Address Line 2

City

State

ZIP Code

What River Valley Campus do you attend?

Host Preferences

How many interns are you interested in hosting?

Which gender would you prefer to host?*

Male Female No preference

What is the time frame you are willing to host? (check all that apply)*

Semester 2 (Jan-May) Summer (June-August) School Year (Sept-May)

Host & Family Information

Please list the names, ages, and relationships to you of all individuals who will be living at your home while the intern is with you.

Names, ages, & relationship of those living in your home

Attach a picture of your family*

No File Chosen

File uploads may not work on some mobile devices.

Please describe bedroom and bathroom space you can provide to the intern? Would the bathroom be shared, is the bedroom near the other bedrooms in the home, etc.

Lifestyle Information

Describe what a typical day looks like in your home. Including general activity level, when you wake up, when you go to bed, typical dinner times, etc...

Does anyone in your home smoke?

Yes No

Do you have any pets?

Please list pets