Name:
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Email Address:
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Date of Birth: (mm - dd - yyyy)
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Citizenship: |
Telephone Number:
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Cell Phone:
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Do you have any allergies or other health issues we should know about? |
Do you have any dietary requirements or wishes?
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Do you have family or friends in the U.S.?
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Please provide a contact name, phone number/email address of a friend or family in the U.S. in case of an emergency:
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Do you have a family or friends who live near the college and will act as your contact "family" while you are at Messiah?
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What language(s) do you speak?
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Would you prefer a family with children?
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What is your major area of study or academic interest?
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What activities or hobbies do you enjoy? (Check 4-5 that applies to you.)
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Does smoking bother you?
Yes
No
No Preference
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What are your personality traits? (Check 4-5 that best describes you.)
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Who is in your family? (e.g. Mom, dad, 1 younger sister, 1 older brother, me)
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Do you like pets? If yes, what kind of pets do you like?
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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
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What kind of church would you like to attend? (particular denomination? no preference?)
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Please provide any other information about yourself or any other preferences you have:
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