Host Family for visiting students sign-up Form

Center for Cultural Perspectives
Host Families Sign-Up Form (for short-term Visiting International Students)

Your Name*

Association with La Salle: *

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone*

Is your contact number: *

If you are a current La Salle parent, what is the name of your child(ren)?*

Grade Level: *

Counselor:

How many adults (18+), including yourself, does your household have?*

How many minors (younger than 18) does your household have?*

Do you currently have visiting student(s) in your household?*

If yes, how many?

Have you ever hosted visiting student(s) in your household?*

If yes, please explain briefly:

Will you be able to provide a Single Room?*

Or will you only be able to offer Shared Room?*

Other? Please describe briefly:

Do you have pet(s) in your house?*

If yes, please describe:

Do you have a preference for the gender of your visiting student(s)? *

If yes, which gender?:

Any other preferences or special family routines you would like us to be aware of? (vegetarian; church participation; community volunteering commitment; etc.)

Please submit your form electronically to Ms. Jialin "Sunny" Sun. You can also print a copy and have your student drop it off at Room #350; For any questions, please contact Ms. Sun at 626-696-4389 or jsun@lasallehs.org. Thank you.

Signature*

Date: *