Student's name *

First Name

Last Name

Program: *

Junior Division (ages 5-13)

Senior Division (high school students age 14-19)

Adult Division (adults ages 20 and up)

Student's date of birth *

MM

DD

YYYY

Student's gender *

Female

Male

English language level: *

Fluent

Good

Fair

Poor

Mother's name (if child is under 18)

First Name

Last Name

Father's name (if child is under 18)

First Name

Last Name

Phone (U.S.)

(###)

###

####

Do you wish to apply for a homestay with an American host family? *

Yes

No

Do you smoke? *

Yes

Sometimes

No

How do you feel about pets? *

I like cats

I like dogs

I like cats and dogs

I like all pets

I do not like pets or animals

I am allergic to animals

All applicants for homestay and hospitality programs under the auspices of the International Hospitality Center are responsible for providing their own personal spending money and incidental expenses. Participants must have valid health, accident, and liability insurance, valid passport, and visa. The International Hospitality Center will not be responsible for any debts or medical expenses incurred during your homestay program. You agree to accept full responsibility for any and all medical and personal expenses incurred, and give permission for such emergency treatment as might be necessary. I, the undersigned, hereby fully accept the responsibilities described above. *

Yes, I agree.