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Family Information Sheet & Questionnaire
Please fill out the information on this screen as completely as possible so your request can be processed in a timely manner. Note that fields marked with an "*" are required.
Your Name*
Your Family Status*
Single
Married
Children - # at Home
N/A
1
2
3
4
5
6+
Time Available for Adopt-A-Student:*
Once a Month
Twice a Month
Three Times a Month
Once a Week
More Than Once a Week
NOTE: Your answer will not disqualify you from being a host family. We will use this to help determine which student's schedule will fit best with yours.
Can you adopt more than one student?
No
Yes
If yes, how many?
N/A
1
2
3
If you have a particular student in mind, please specify student's name here:
Do you have a preference regarding gender?
No
Yes
If yes, which gender?
N/A
Female
Male
Your Street Address:*
City:*
State:*
Zip:*
Your Phone Number:*
Your E-Mail Address:*
Do you have pets?
No
Yes
If yes, what type?
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Do you have questions about God, the Bible and Christianity?
Do you want the assurance of eternal life?
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