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Augustana University: Friendship Family Questionnaire
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Age
*
Your answer
Partner's First Name
Your answer
Partner's Last Name
Your answer
Partner's Age
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Alternate email
Your answer
Phone
*
Your answer
Occupation
*
Your answer
Partner's Occupation
Your answer
Children (list age and gender)
*
Your answer
Religious Affiliation
Your answer
Service or Civic Organizations
Your answer
Languages spoken/studied
Your answer
Foreign Countries visited
Your answer
Are you currently matched with an Augustana student? If yes, what is their name?
Your answer
Would you be willing to host more than one student?
Yes
No
Maybe
Clear selection
If yes, how many?
Your answer
Please check any of the following activities that you and your family enjoy.
Music
Movies
Biking
Reading
Theatre
Dancing
Cooking
Swimming
Outdoor Life
Walking
Travel
Watching sports
Playing sports
Photography
Chess/card/board games
Politics/current events
Crafts
Gardening
Other Interests
Do you currently prepare meals with any dietary restrictions in your household? Would you be willing to host a student who has specialized needs (vegetarian, halal, allergies, etc.)
Your answer
Do you have pets? Please list type & breed.
Your answer
Does anyone in your family smoke?
Yes
No
Clear selection
Would you accept a smoker in your home?
Yes
No
Clear selection
Does any member of your household have a serious illness, condition, or allergy that the student should be aware of? If so, please specify below.
Your answer
If you have a strong preference regarding gender or nationality of your student, please indicate below. We will attempt to accommodate your request, but we cannot guarantee that we will be able to.
Male
Female
No preference
Clear selection
Nationality preference?
Your answer
If you've previously hosted, any feedback you'd like to share? For all potential and returning Friendship Families, any other comments, concerns, or questions?
Your answer
How did you hear about the Friendship Family Program?
Your answer
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