Friendship Family Application
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First Name
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Last Name
Preferred Name
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Home Address
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City
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State
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Postal Code
Home Phone (xxx-xxx-xxxx)
Cell Phone (xxx-xxx-xxxx)
Email Address
Date of Birth
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Please list your occupation
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What are your interests?
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Religious Affiliation
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Marital Status
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Number of Family Members
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Please list all residents in your home
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Ages of Children
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Please list any pets you may have in your home
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Your preferred student would share what kind of cultural background?
Your preferred student would identify as which sex?
Female
Male
No preference
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Your preferred student would share what kinds of hobbies?
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Do you smoke?
Yes
No
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Do you speak a second language?
Yes
No
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If yes, please specify
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Would you be willing to host more than one student? (Willingness to do this is not a requirement to serve as a friendship family.)
Yes
No
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Would you be willing to have your student(s) stay with you during Thanksgiving week and/or Spring Break, when residence halls are closed? (Willingness to do this is not a requirement to serve as a friendship family.)
Yes
No
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What sleeping accommodations would you be able to provide for the student?
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If you were a friendship family, how often during the academic year would you want to interact with your student?
Once a semester
Once a month
As often as the student wants or needs
Other
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If you were a friendship family, what would you look to provide the student?
Pick them up from the airport when they arrive in Lexington
Provide housing and/or storage space during the summer
Provide housing if they have nowhere to go when the residence halls close (Thanksgiving and Christmas break
Take them on trips to acquaint them with Lexington and/or Kentucky
Have them over for dinner
Take them to the airport when they must return home
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Why are you interested in the Friendship Family Program? What role do you see yourself playing as a host?
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Indicates Response Required