Iowa Wesleyan College

Adopt A Student 2012 Host Form

Please submit your application for consideration. You will be notified by email within the following weeks with your first year student's contact information. **Please keep in mind, if chosen as a host, our initial meeting with students will be during New Student Orientation, which is the week of August 15th. The specific date and time of the event will be in the information you receive with your matched student. There will be other events during the year about which you will receive notification.

First Name:
Last Name:
IWC Class year
If applicable:
Telephone Number:
Email Address:
Academic Interests:
Extra-Curricular/Free-time Activities:
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How many students are you willing to adopt?:
1
2
Were you a first generation college student? (First in the family to go to college):
Yes
No
Do you smoke?:
Yes
No
Would you mind a student(s) who smokes?:
No
Yes
Would you mind a student(s) with dietary restrictions?:
No
Yes
Do you have any pets?
If yes please explain:
Do you have any children?
If yes please list their ages:
How often would you like to meet with your student?:
Once a month
Once a week
Once a semester
Other:
Would you have any "common ground" with a student from a specific geographic or religious background?:
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3
4
5+
Yes
No
Can you provide off-campus transportation if necessary?:
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Please provide any additional information or comments:
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