Host Family Student Application 
This survey is meant to capture personal information that will assist the Host Family program with matching students with a family they are comfortable with. Thank you for your participation. 
Email *
First & Last Name?  *
Nickname?  *
What is the best number to reach you?  *
What is your date of birth  *
MM
/
DD
/
YYYY
What is your gender?  *
Do you have any relatives in the Newton area?  *
Required
What is the area that you want to major in?  *
What activities are you planning to participate in at Bethel College?  *
Please share your musical interests and/or hobbies.  *
Please share your food preferences (Meats, Potatoes, Breads, Vegetables, Fruits, Desserts, Snack foods?  *
Please list any foods you DO NOT like.  *
Do you wish to attend a church while attending college?  *
Required
What denominational church would you like to attend?  *
Required
Do you have a car?  *
Required
Would you like for your host family to attend your activities and parent activities during the college year?  *
Required
Do you have any special medical needs the host family should be aware of and/or give support? Please share.  *
Are you an international or U.S. citizen?  *
Do you prefer a host family with a similar cultural background?  *
Do you have brothers and sisters? If yes, how many and what are their names and ages?  *
What is your Mother's name, home phone, email and place of work?  *
What is your Father's name, home phone, email and place of work? 
 *
A copy of your responses will be emailed to .
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