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Adopt-A-Student

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
Time Available for Adopt-A-Student:*
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?
If yes, how many?
If you have a particular student in mind, please specify student's name here:  
Do you have a preference regarding gender?
If yes, which gender?
Your Street Address:*  
City:*  
State:*  
Zip:*  
Your Phone Number:*  
Your E-Mail Address:*  
Do you have pets?
If yes, what type?
 
 
 
 
 
 
 














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