Form

I want to host a student!
When you are a full-time host, your student is with you 24/7. Group activities are: International Dinner, Lancaster County Amish Tour and Sight and Sound Christmas show.
*Students are not expected to babysit small children. We expect that all our host families will always have an adult family member physically available to the student at all times.
Part-time hosts have their student evenings, weekends and holidays. They agree to take their student to the activities center at Hinkletown Mennonite Church other days. Drop off times are 8:00-9:00 AM and pickup times are 5:00-6:00 PM.
Your hosting preference:

I will host my student 24/7 I will take my student to the activity center every day
Personal Information
First name*
Last name*
Age*
Occupation
Spouse's first name
Spouse's age
Spouse's occupation
Name(s) and age(s) of child(ren) at home
Name(s) and age(s) of child(ren) away from home
List some of the interests and hobbies of your family members. We do our best to match students and familes with common interests.
Contact Information
Street Address*
State*
Town*
Telephone number*
Cell phone number
Email address*
International Experience
How many times have you hosted international students through CIH in the past?*
Languages spoken other than English
Describe any overseas or mission field experiences you have had
Accommodations
This year we are hosting only female students
CIH requires that each student have their own bed. Will the student be sharing a bedroom or bathroom? If so, with whom?*
I can host:*

One student Two students Three students
Any additional comments or questions?
References
Reference #1 name*
Relationship*
Telephone number*
Email address
Reference #2 name*
Relationship
Telephone number*
Email address
Reference #3 name*
Relationship
Telephone number*
Email address
Miscellaneous
Church you attend
CIH is a non-smoking program. Is your household willing to comply with this?*

Yes No
Please check any pets you have in the house

dog cat bird hamster, mouse, gerbil, or guinea pig farm animals (cow, pig, chicken, goat, etc.)
Are you willing to modify your meals to accommodate a student's health issues or diet choices? If yes, check which ones

Vegetarian diet No pork No beef
I am willing to help by

Coming early to the International Dinner to set up tables & chairs Stay after the International Dinner to help clean up I have an idea for a student activity I can provide student transportation for an activity someone else plans I want to link up with other host families and students for activities
Any additional comments or questions?
Should be Empty:

I want to host a student!

Personal Information

Contact Information

International Experience

Accommodations

References

Miscellaneous