Names:

Email Address:

Children's names and ages: (ex. Scott-9, Amanda-6)

Home Address:

Is there a student (or students) at Messiah College with whom you already have a connection?

Yes
No

If Yes, Please Provide Name(s):

We are able to host two students over:

Christmas Break
Spring Break
Both

Our family would connect best with:

Female Student
Male Student
No Preference

Language(s) spoken at home:

What activities or hobbies do you and your family enjoy? (Check 4-5 that apply.)

How much time do you anticipate spending or being in touch with your friendship student(s)?

Weekly
Every Other Week
Monthly
2-3 Times a semester

Anything else about yourself or your family that could help us in the matching process?
(e.g. pets, anyone in your family who smokes, etc.)