Friendship Family Interest Form

* = required field

Why do you and your family want to participate in the Friendship Family program*
How do you think your student will benefit by becoming part of your family*
Last name:*
First name(s):*
Home Address:*
Zip code:*
Phone Number:*
Best time to reach you at home:*
E-mail address:*
Number of family members participating in the program:*
Have your previously participated in Luther's Friendship Family Program?*
I'd prefer a student who is:
I would be willing to outreach to my student (please check all that apply)
Please select the top 3 activities that are important to you and your family*
If Other please specify
Do you have any pets? if yes please specify
We/I would be interested in hosting more than one international student.
How did you hear about the program
Have you ever been convicted of anything other than a traffic violation?*
If Yes, please specify or contact the Diversity Center