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IHP Host Family Request Form
Please complete this form if you are an international student requesting an IHP Host Family. There is a wait for host families, we will try our best to place ASAP. Thank you!
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* Indicates required question
Email
*
Your email
Last/Family Name
*
Your answer
First Name
*
Your answer
Current Address in the U.S.
*
Your answer
U.S. phone#
*
Your answer
Home Country
*
Your answer
Email Address (SIUE email is preferred)
*
Your answer
Gender
*
Male
Female
Marital Status
*
Single
Married
Major at SIUE
*
Your answer
Program Level
*
Undergraduate
Graduate
Special Interests (e.g. music, travel, food and so on)
*
Your answer
Do you have any diet restrictions or allergies?
*
Yes
No
If you have diet restrictions or allergies, please list below:
Your answer
If you feel comfortable sharing your vaccination status, please choose one of the following:
*
Not Vaccinated
Fully Vaccinated
Do Not Wish to Share Vaccination Status
Are you willing to share something about your home country with community groups?
Yes
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