EmailMeForm
Friendship Family Interest Form
If you have questions email lindsay.bienemann@wartburg.edu.
Contact Name
*
First
Last
Family Members (please list all other people living in your home and ages of minors)
*
Primary Phone
*
###
-
###
-
####
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Email
*
Occupations
*
Pets in the home
*
Yes
No
If yes, what kind of pets
Family interests (please select all that apply)
*
Sports & Outdoor Activities
Arts, Music & Theater
Volunteering/Community Service
Cooking & Sharing Meals
Travel & Culture Events
Games & Movies
Faith/Religious Activities
Other (please list below)
Other family interests
How often would you like to interact with a student
*
Weekly
Monthly
Seasonal
Other
If you selected other, how often would you like to interact with a student
What level of support are you comfortable providing
*
Casual Social Gatherings
Cultural Experiences
Transportation Assistance (doctor appointments, Walmart runs, etc.)
Holiday Celebrations & Family Traditions
Mentoring
I am willing to help transport international students
*
Yes
No
Are there any restrictions or preferences we should be aware of
*
Do you have a region or country of origin preference
*
Yes (please specify below)
No
If yes, please specify
Do you have an academic/major interest preference
*
Yes (please specify below)
No
If yes, please specify
Spoken Languages
*
Countries Traveled To
*
Religious Affiliation
*
Is there anything else you would like us to know when making your match
*
Can we share your demographic information with other families
*
Yes
No
