Name and Address First Name * Last Name * Street 1 * Street 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Contact Information Cell Phone * Home Phone Work Phone Email Address * Confirm Email * About You Occupation * College/University Attended Year of Graduation from College/University (Undergraduate) How did you learn of the Host Program for International Students? * Host Program Email Invitation Harvard Affiliate Harvard Resources Interests * (please list at least two) Languages Spoken (other than English) Spouse or Partner Do you have a spouse or partner? * Yes No About your Spouse or Partner(required if answered Yes) First Name Last Name Email Address Confirm Email Occupation College/University Attended Year of Graduation from College/University (Undergraduate) Children Do you have children? * Yes No About Your Children(Required if answered yes)Child 1 Age Gender Male Female Child 2 Age Gender Male Female Child 3 Age Gender Male Female Child 4 Age Gender Male Female Pets Do you have pets? * Yes No If yes, please list all animals in your home * Preferences About Your Host Student Preference (your preference may not always be available) Nationality/Region(please make at least one indication) 1 2 3 No preference No Preference Would you prefer your student to be: * Single with a spouse/partner with a family (i.e. children) No preference When would you be available to welcome your student(s)? * Most students arrive from late July to early September. Other Comments
