Host Family Application Form for ELI Students

If you are an ELI student and you wish to have a host family, please complete this form.

*(denotes required field)

First Name: *

Middle Name:

Last Name: *

E-Mail Address: *

E-Mail Address again: *

Please enter your E-mail Address a second time.

Is this your first request for a host family?

Please choose: *

Gender: *

Date of birth: *

How old are you?

Age: *

Where are you from?

Country: *

What is your local address (here in the USA)?

Address: *

Phone number:

Is this a cell phone?

Religious Information

We use this information to try to find a family with the same religious interest as you, if applicable.

Do you follow a religion?

Please choose: *

If so, which religion do you follow?

Religion:

Would you like to attend church with your host family?

Please choose:

Education Information
What are your levels at the ELI right now?

Listening/Speaking level: *

Reading/Writing level: *

How many months do you plan to study at the ELI?

Number of months: *

If you are a student, what is your university major?

Major:

Additional Information

Do you smoke? *

Do you have a car? *

Do you like cats? *

Do you like dogs? *

Are you married? *

If so, which family members are here in Delaware with you?

Family members:

What are your interests?

Interests: *

What are your future plans?

Plans: *

Host Family Application Form for ELI Students

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