Exchange Student Hosting Information Request


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Host Family Information - Form A

Area Team/Chapter Name(Optional) :
High School Name :
State*:
Are you applying to host a student for:	AFS Event (1-4 days) Welcome (up to 6 weeks) Semester (school semester) Year (school year)

Host Parent #1 Information

Click here if single-parent household.

Gender*:
MaleFemale

First Name*:

Last Name*:

Occupation :

Employer Name :

Work Phone :
( ) -

Mobile Phone :
( ) -

Ethnicity (Optional) :

If Other, please enter :

Host Parent #2 Information

Gender*:	MaleFemale
First Name*:
Last Name*:
Occupation :
Employer Name :
Work Phone :	( ) -
Mobile Phone :	( ) -
Ethnicity (Optional) :
If Other, please enter :

Contact Information

Home Address 1*:

Home Address 2 :

City*:

State*:

ZIP Code*:

Home Phone*:
( ) -

Email :

Fax :

Family Members

Name	Relationship	Living at home?	Date of Birth (mm/dd/yyyy)	Country of birth
Host Parent #1		YesNo

Host Parent #2

YesNo

Children and Other Family Members Start Here

YesNo

Home Address 1*:
Home Address 2 :
City*:
State*:
ZIP Code*:
Home Phone*:	( ) -
Email :
Fax :