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 Center for Intercultural Engagement and Student Success
(Please don't fill in this field.)
(Please don't fill in this field.)
(Please don't fill in this field.)
(Please don't fill in this field.)