Adopt a Student

General Information

First Name

Last Name

Cellphone Number

Email

Zip Code

What local church do you attend?

Occupation and Educations - This information helps us match hosts and students with similar professional or academic goals when possible

About you - hobbies/interests, community/organizations, etc.

Would you be more comfortable with male or female student?
MaleFemaleNo Preference

Are you interested in adopting more than one student?
YesNo

Do you have any pets? If so, what kind?

Does your household have any restrictions due to COVID? If so, please explain.

__________________________________________________

Household Information

Name of Spouse/Housemate(s)

Occupation and Educations of Spouse/Housemate(s)

Name(s) and Age(s) of Children Living at Home

Name(s) and Age(s) of Children not living at home

____________________________________________

Personal References - Please provide information for two personal references. One reference must be a church pastor/leader.

Reference 1 First Name

Reference 1 Last Name

Reference 1 Phone Number

Reference 1 Email

Reference 2 First Name

Reference 2 Last Name

Reference 2 Phone Number

Reference 2 Email

______________________________________________

Completed Code of Conduct Form

Completed Responsibility Contract

Are you willing to complete and pay for a background check for each person in your household 18 years old and over?
YesNo

Any other information you would like to share?