GKC PEOPLE TO PEOPLE - STUDENT APPLICATION

INT'L STUDENT HOST PROGRAM

STUDENT INFORMATION
First Name:
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Last Name:
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Address:
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Address:
City:
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State:
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Zip Code:
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Email Address:
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Home Phone
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Cell Phone
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Work Phone
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University/College Attending
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Year Enrolled (Freshman Sophomore Junior Senior) + level of education (ex: BA Master's PhD)
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Major
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Second Major/Minor
Age
Smoker (Y/N)
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Languages Spoken
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Birth Country/Residence
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Extra-Curricular Activities Clubs
Religion/Church
Volunteer/Civic organization belong to:
Sports/Hobbies/Interests
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Allergies dietary needs food limitations
Have transportation (Y or N)
Have you participated in this program before? (Y or N) If Yes when?
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Emergency Contact (Name Phone Email)
*

Please answer the following questions to better serve your needs:

1) What is your primary reason to enroll into this hosting program

2) How did you hear about this program?

I Certify that I (spell your name in the box) am at least 18 years of age.
*
I promise to be available to meet with the hosting family at least 3-5 times a year.

Signature & Date
*

Mailing list signup:
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Security code:
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