New Host Family Application Form
Email address *
Date of application *
MM
/
DD
/
YYYY
How did you hear about GlobalPittsburgh? *
Your answer
Your Name *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
ZIP Code *
Your answer
Date of Birth *
Your answer
Marital Status: *
Do you have children?: *
Current Employer: *
Your answer
Title: *
Your answer
Regular Work Hours *
Your answer
Work address
Your answer
Phone:
Your answer
Education *
Your answer
What are your hobbies and interests? *
Your answer
What languages do you speak besides English?
Your answer
If you have traveled internationally, what countries have you visited/lived in?
Your answer
What type of cuisine do you generally prepare for dinner (American, Asian, Italian, Kosher, vegetarian, vegan, ect.)?
Your answer
Is your home accessible by public transportation? *
Please explain your answer (e.g., closest bus or T stop)
Your answer
Would you prefer to host: *
What is the minimum age of a guest that you will be willing to host? *
Your answer
Are there any restrictions of which you would like us or your guest to be aware?
Your answer
Does your family have (a) cat(s)? *
If yes, how many?
Your answer
Does your family have (a) dog(s)? *
If yes, how many?
Your answer
Do you or any member of your family smoke? *
Do you allow smoking in your home? *
Would you host a student who smokes? *
Do you have wifi in your home? *
Will the student have a private bathroom? *
Your answer
Will laundry facilities be available to your guest? *
List any other facilities that will be available for your guest to use
Your answer
How many bedrooms are available for your guest(s)? *
How many guests can you host at the same time? *
Can you provide your guest(s) with breakfast and dinner for additional compensation?
Next
Never submit passwords through Google Forms.
This form was created inside of Globalpittsburgh.org. Report Abuse - Terms of Service