University*of*Hawaii*at*Hilo*
HOST*FAMILY*REQUEST*FORM*
Thank&you&for&your&interest&in&being&hosted&by&a&family&in&the&Hilo&community.&&The&purpose&of&
this&form&is&to&gathe r&inform a tion &ab ou t&yo ur&in te re st s&s o &th a t&we&can&try &to &match&you&with&a&
family&with&similar&interests.&&Please&return&this&form&to&the&International&Student&Services&office,&
Room&EA202&or&EA204&in&the&Student&Services&Center&or&email&it&to&mellon@hawaii.edu.&
Name:&&__________________________________________________________________&
Phone&Number:&&&_______________________& UH&ID&Number:&&____________________&
Email&Address:&&______________________________&
Male& &Female&
What&country&are&you&from?&&__________________________________&
Approximately&how&often&would&you&like&to&spend&time&with&a&host&family?&
Once&or&twice&a&semester,&mainly&o n &h o l id a y s&
More&than&a&couple×&a&semester&
Do&you&prefer&to&visit&a&family&with&another&student?&
Yes&
No&preference;&by&myself&or&with&another&student&is&OK&
Are&you&interested&in&visiting&a&family&for&occasional&overnight&stays&or&just&for&a&
day?& Just
&for&a&day&at&a&time&
&&&&&&&&& &Overnight&stays&is&OK&
Do&you&enjoy&being&around&young&children&and/or&teenagers?&
Yes& No&
Do&you&enjoy&being&around&animals&(such&as&dogs&and&cat
s)?
&Yes& No&
List&interests&and&activities&you&enjoy:&
Going&to&the&beach& Hiking&
Barbeques,&potlucks& Church&
Sightseeing&around&the&island&
Attending&special&events&(e.g.,&concerts,&plays)&
Sports&(list&sports:)&&______________________________________________&
Other&(please&list:)&&______________________________________________&
Anything&else&you&would&like&to&add&or&let&us&know?&
____________________________________________________________________&