Name:


Email:


Street Address:


City:


State:


Zip:


Phone Number:


Church Affiliation:


How many members in your household?
Adults:        Children under 18:

I am interested in hosting (check one):
2 international students (+ 2 potential domestic students)
3 international students (+ 3 potential domestic students)
4 international students (+ 4 potential domestic students)


The reason(s) I would like to be involved in this program is (are)…

References:

1. A Staff Member from your church



2. Additional reference from your church (i.e., staff member, pastor, congregant)

If you have any questions please contact University Ministries @ 773.244.4980.