Iowa Wesleyan College

Adopt A Student 2012 Student Form

Please submit your application by Friday, August 5 for consideration. You may be contacted by your host family within the following few weeks. **Please keep in mind your initial meeting with your host family with be during New Student Orientation**

Please be as specific and detailed as possible when answering each question. If will help us match you and your host.

First Name:
Last Name:
Address:
City:
State:
Country:
Zip:
Telephone Number:
Cell Phone Number:
Email Address:
Academic Interests:
Extra-Curricular/Athletic Interests:
*
*
*
*
*
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*
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Canada:
Gender:
Male
Female
Are you a first generation college student:
Yes
No
Do you smoke?:
Yes
No
Would you mind a host who smokes?:
No
Yes
Would you prefer a host with children?:
No
Yes
Do you have any dietary restrictions?
If yes please explain:
Do you have any animal allergies?
If yes please explain:
Either
How often would you like to meet with your host?:
Once a month
Once a week
Once a semester
Other:
Please briefly describe why you would like to be a part of this program, what activities you hope to enjoy with your host family, specific aspects of Mt. Pleasant you would like to see, and any other information you would like to share: