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Friendship Family Student Questionnaire
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Gender?
*
Your answer
Age
*
Your answer
Campus Box/Address
*
Your answer
Home Country
*
Your answer
Phone
*
Your answer
Religious Affiliation
Your answer
Major(s) at Augustana
*
Your answer
Language(s) Spoken
*
Your answer
I plan to study at Augustana for
*
1 semester
1 year
3+ years
Other:
Siblings (list name and age)
*
Your answer
Please check any of the following activities that you and your family enjoy
*
Music
Movies
Biking
Reading
Theatre
Dacing
Cooking
Animals
Swimming
Outdoor Life
Walking
Travel
Watching Sports
Playing Sports
Winter Sports
Phitigraphy
Chess
Politics
Crafts
Gardening
Required
Other interests and/or talents
*
Your answer
Would you accept a family that has pets?
*
Your answer
Do you smoke?
*
Yes
No
Would you accept a family that smokes?
*
Yes
No
Do you have any dietary restrictions that a family should be aware of?
Your answer
Do you have any serious illness, condition or allergy that the family should be aware of? If so, please specify below
*
Your answer
Comments: Please use the space below for any additional comments, questions or concerns.
*
Your answer
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