Homestay Submission FormPlease enable JavaScript in your browser to complete this form.Family Name(s) *Street Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Preferably your home phone numberEmail *What is the distance from your house to Missio Seminary? *Please use Google Maps to figure the mileage to the 200 N Main St, Hatfield campus.Minutes driving & walking to the campusHomestay owners may have to provide transportation if the homestay is located more than five miles from the campus until the student purchases a car.Preferred Duration of Student's Stay *3 months6 months12 monthsNegotiableHomestay Host #1 *FirstLastHost #1 Additional Phone NumberMobile phoneWork phoneOtherHost #1 Year of Birth *Host #1 Occupation and Location of Workplace *Homestay Host #2FirstLastHost #2 Additional Phone NumberMobile phoneWork phoneOtherHost #2 Year of BirthHost #2 Occupation and Location of WorkplaceOther Inhabitants of HouseFor each, please list name, year of birth, occupation, and relationship to host #1Does anyone in the household have special dietary practices/restrictions? *YesNoPlease explain:Do you own any pets? *YesNoWhat kind and how many?Are there any smokers living in your home? *YesNoWhat is your religious affiliation? *Examples: Buddhism, Christianity, Hinduism, Islam, Judaism, Non-religious, otherLanguages spoken in the home: *What countries have you visited outside the US? *What are the interests and hobbies of the household members? *Preferred student gender: *MaleFemaleNo preferencePreferred personality: *A more independent studentSomeone who wants to spend time in activities with your familyNo preferenceHow many students are you able to house in private bedrooms? *What kind of accommodations are you able to provide? *$500 with no meals, kitchen access for cooking$700 with a meal per day, kitchen access for cooking$800 with two meals per day, kitchen access for cooking$900 with three meals per day, kitchen access for cookingPlease mark ALL which applyType of house: *Ex: Colonial, Ranch, Cape Cod, Townhouse, Apt, etc.Number of levels: *Number of bedrooms *Number of bathrooms: *Other details:Ex: big yard, basketball hoop, on farm, etc.Please mark ALL which apply to your home: *Wireless internetFire extinguisherSmoke detectorsAir conditioningWasher and dryerTV available for student usePrivate bathroom available for each studentAccess to kitchenRice cookerOtherOtherCommentSubmit
