BREAKING BREAD - Host Application
Please answer completely
Please enter your first name
Please enter your last name
Please enter your occupation
I Am A:
Please choose one
(Street, City, & Zip Code)
Names Of Other Host Participants
(Only if you will be hosting with non-family members as a "group host." Please separate each name with a comma.)
Please enter your email
Please enter a phone number by which you can be reached during the day
Please enter a phone number by which you can be reached during the evening
How Did You Hear About Breaking Bread?
Please Write A Brief Description Of Yourself, And Your Family
Ages, what is important to you, pets, hobbies, interests, etc.
Community & Professional Affiliations
Church, religious/civic groups, memberships, etc.
International Interest, Experience And Background Including Languages Spoken (foreign lan. not necessary)
Can You Provide Transportation To And From Your Home
Please indicate yes or no
How many Students/Scholars Would You Be Willing To Host?
(Please enter 1, 2, or another exact number)
Are You Comfortable With Cooking For Dietary Restrictions?
Please select all the apply
I am not comfortable cooking for dietary restrictions
Vegetarian + no egg
Please select all the apply. By checking you acknowledge that if your preferences cannont be met, an alternate assignment will be accepted
Male (single persons will be matched with persons of the same sex)
Female (single persons will be matched with persons of the same sex)
Please Agree To The Terms
By checking this box I agree to the following terms: Yes, I want to host an international student or scholar through the Breaking Bread Program. I understand that this program matches persons solely for the purpose of sharing ONE meal together. I will respect the culture, religion, beliefs and customs of the international student/scholar and will make no attempts to proselytize or recruit for religious or other groups. I will inquire with OIS or with the student regarding any dietary restrictions of the student or scholar before hosting him/her. I understand that my responsibilities are only for hosting one meal and completing an evaluations form after my participation in the program.
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