CIH Host Family Application

**Press tab after each entry.

First Name:
Last Name:
Address:
City:
ZIP:
Home Phone:
Work Phone:
E-mail:
Church Organization:
Desired Hosting Dates: Week One-Dec 18-26:
Desired Hosting Dates: Week Two-Dec 26-Jan 2:
Number of Students I can host:
Male:
Female:
Married Couple:
Smoking?:
Country of Preference: