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Intercultural Office

Friendship Family Application - For Students


Email Address:

Date of Birth:
(mm - dd - yyyy)


Telephone Number:

Cell Phone:

Do you have any allergies or other health issues we should know about?

Do you have any dietary requirements or wishes?

Do you have family or friends in the U.S.?

Please provide a contact name, phone number/email address of a friend or family in the U.S. in case of an emergency:

Do you have a family or friends who live near the college and will act as your contact "family" while you are at Messiah?

What language(s) do you speak?

Would you prefer a family with children?

What is your major area of study or academic interest?

What activities or hobbies do you enjoy?
(Check 4-5 that applies to you.)

Biking Bowling Cooking
Church Activities Fishing Gardening
Golfing Hiking Movies
Musical Activities Reading Shopping
Sports Events Theatre / Acting Volunteering
Technology Travel  

Does smoking bother you?

No Preference

What are your personality traits?
(Check 4-5 that best describes you.)

Outgoing Shy Introverted
Extroverted Active Outspoken
Sensitive Studious Creative
Sarcastic Humorous Outdoorsy
Spontaneous Hardworking Independent
Patient Organized Loyal
Energetic Friendly Ambitious

Who is in your family?
(e.g. Mom, dad, 1 younger sister, 1 older brother, me)

Do you like pets? If yes, what kind of pets do you like?

I would prefer:

A more active family
To just have a family available (I don't expect to spend much time with them)
No Preference

What kind of church would you like to attend?
(particular denomination? no preference?)

Please provide any other information about yourself or any other preferences you have: