Family Application - Butler University

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American Family Dinner Program - Family Information

Date:

Adult Name(s) 1*

Adult Name(s) 2

Adult Name(s) 3

Children Name(s) 1

Children Name(s) 2

Children Name(s) 3

Mailing Address:*Cannot exceed 100 characters.

Home Phone:

Work Phone:

Cell Phone:

E-mail:

What is the best way to contact you?

Do you have any pet? If so, what kind?

Do you have any preferences for type of student you would like to host?(gender, nationality, language?)

Can you accommodate dietary restrictions (vegetarian, no pork, kosher) if a student has them?

Yes

Are there any nationalities or language speakers you would prefer not to host?Briefly describe the areas of work that adults in your family are involved in, e.g. business, arts, home-making:Is there anything else that you would like to mention about you that might be helpful in matching you with a student?