HOST FAMILY.doc

HOST FAMILY APPLICATION FORM 寄宿家庭申请表 The host family program is a very important feature of the cultural and language immersion aspect of the NSLI-Y exchange experience. Thank you for your interest in hosting a NSLI-Y student. 寄宿家庭体验是NSLI-Y交换学习体验项目中学生对于语言文化体验环节中最重要的一个部分。非常感谢您愿意接收我们的学生到您的家庭寄宿。 Program Duration Dates 项目日程 Beijing: July 14 - July 15; Harbin: July 16 – Aug. 1; Kunming: Aug. 1- Aug. 21; Shanghai Aug. 22 北京：7.14—7.15； 哈尔滨：7.16—8.1； 昆明：8.1---8.21； 上海：8.22 ABOUT STUDENT AND FAMILY 接待家庭信息 Name of student 学生姓: Student Email: 学生邮箱 Host Family Name 户主姓名: Host Family Phone: 户主电话 Host Family Physical Address详细住址: Host Family Mailing Address邮寄地址: ? ? ? ? Host Family Email : 寄宿家庭邮箱 Distance from home to School: 距离（西南林业大学）有多远： Host Mother Details 寄宿家庭母亲的信息 Host Father Details 寄宿家庭父亲的信息 Full Name姓名: Full Name 姓名: Occupation工作 : Occupation工作 : Work Phone工作电话 : Work Phone工作电话 : Mobile Phone手机 : Mobile Phone手机 : Married 已婚 Separated分居 Widowed丧偶 Divorced离异 Choose one户主婚姻状况: FAMILY MEMBERS家庭概况 Name, beginning with parents Relationship Living at home? Birth Date Country of Birth 名字（从家长开始） 关系 住在家? 出生日期 出生国家 PLACEMENT INFORMATION Religious affiliation, if any（有何宗教信仰）: ___________________________ Our family can host a male female no preference 我家能接受（男/女）学生 3. Have arrangements been made for the participant to have a bed of his/her own? 学生会不会有自己的床? yes no Will the participant share a bedroom? 寄宿学生是否与别人共用卧室? yes no If yes, with whom? 如果是, 跟谁?___________ 4. Does anyone in the family smoke? 你家有人抽烟吗? yes no If YES, would that person be willing to not smoke around the NSLI-Y student? 如有，可否不在室内和车内抽烟？ 5. Do you have any pets? 你们有宠物吗? yes no What kind?是什么宠物________ 6. Are you willing to host a vegetarian? 你愿意接受一名食素学生吗？ yes no 7. What languages are spoken in the home? 在家中说什么语言