EmailMe Form - HomeXchange Host Application

Name *

First Middle Last

Email *

Phone *

### - ### - ####

Gender *

Male

Female

Job/Occupation *

Marital Status *

Married

Single

Divorced/Widowed

Spouse's Name

First Middle Last

Job/Occupation

Children's names, ages, genders

Example:
Joe, 4 yrs old, boy
Maryam, 2 1/2 yrs old, girl

Total number of people currently living in the home *

Home Information

Please provide CALX and potential HomeXchange Students with some basic information about your home.

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Type of home

House

Townhouse/Condo

Apartment

Mobile home

No. of bedrooms

No. of bathrooms

Describe the room/space where the student will stay. *

Home Life

Tell the potential student a little about your home life and interests.

What is your typical day/week like?

What are your hobbies?

Expectations of the Student

Are there any expectations you have for your Student? (Chores, household responsibilities, family rules, places they shouldn't go in the house, how they should interact with your kids, etc.)

Do you have pets?

Yes

No

If yes, describe.