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H O M E S T A Y    A p p l i c a t i o n    -    A r a p a h o e

Do you want to fill out a paper application and fax or mail it instead?  Click here.
 
Today's Date:       When do you plan to arrive in Denver?

Month

  Day

  Year
      
      
Which term do you plan to start at Spring?  
 Winter Term     Spring Term     Summer Term     Fall 1 Term      Fall 2 Term
 Other - Explain:
 
Family (Last) Name: First Name: Nickname?
              
Sex: Native Language: Religion:
   Male  (man)
   Female  (woman)		  
              
Date of Birth:    

   

Month

Day

Year
         
              
H O M E   A D D R E S S
Number and street:
City: State/Province: Country:
Telephone Email Address:  
 
              
P E R S O N A L    I N F O R M A T I O N
Foods you like a lot:     
Foods you cannot eat:  (If you can eat anything, please write "none".)
  
Health problems, if any (allergies, etc.):  (If you don't have any problems, write "none".)
  
    
English listening and speaking ability:   Poor     Fair     Good     Excellent
 
Do you smoke: If you smoke, are you willing to smoke outside?
       Yes
       No		       Yes
      No		     
              
Please describe yourself:  (you can choose more than one)     
Shy     Outgoing     Studious     Independent     Other - Explain:
              
Why do you want to live with an American family?      
    
           
P E R S O N A L    I N T E R E S T S    A N D    H O B B I E S  
Choose all that you like:
 Exercise     Movies     Shopping     Dancing     The Arts     Travel     Camping
 Snowboarding     Skiing     Hiking
 Playing sports - List:   
Watching sports - List:
 Listening to music - What kinds?
 Playing a musical instrument - Which one(s)?
How important is high-speed Internet service to you?  Not important     Somewhat     Very important
 Other interests and hobbies - What?
 
 
PLACEMENT PREFERENCES
[We cannot guarantee that all of these will be met]
   
Do you want a family with children?   Yes     No     Not important
If you answered "YES," what ages do you prefer? 
 
Do you want a family with pets?   Yes     No     Not important
If you answered "YES," what animals do you like? 
 
Other preferences or concerns:
 
 
 
I will e-mail a recent photo of myself to missy@spring-usa.com  YES     NO
 

Please note that you will not be notified of your host family placement until approximately one month before your arrival in the United States.
 

PLEASE CHECK YOUR FORM, THEN CLICK THE "SUBMIT" BUTTON BELOW.
    

        

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