Request edit access
SUSI Religious Diversity and Democracy Host Family Application
Thank you for your interest in hosting international undergraduate students for a weekend homestay! Please answer the information below so we can learn more about you and your family. The questions listed here will help us select diverse families that meet the needs of our students. If you have any questions or concerns you can reach out to Andi Laudisio at afl@dialogueinstitute.org. The 2024 opportunity is July 12-14th.
Sign in to Google to save your progress. Learn more
Email *
Name 
Email
How did you hear about this opportunity? 
How many family members live in your home (caregivers, children, family members)? Please tell us about them. 
Are you willing to complete a criminal background check to ensure compliance with the Department of State? (This is standard protocol for all Department of State homestay programs and will be paid for by the Dialogue Institute)
Clear selection
Are you able to provide separate beds for the host students in your home? 
Clear selection
What is your family's ethnic and religious background?
Clear selection
Why do you want to host SUSI students?
Have you hosted students previously? 
Clear selection
If you answered yes to hosting students please elaborate on the nature of the event below
Please list any pets in the home below 
What city do you live in? 
Can you commute to Temple University for student pick up and drop off? 
Clear selection
What kind of activities would you be interested in providing for the students? 
What values are important to your family and in your home? 
Are you willing to accommodate any possible dietary needs (halal, pescatarian, etc) ?
Clear selection
Do you have any questions or concerns? 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Dialogue Institute.

Does this form look suspicious? Report

Google Forms