If you would like to be matched with a student, please supply the following information about yourself: I/We would like to host an international student for the 2012-2013 academic year: Yes No I/We are unable to host this year, but would like to be contacted in 2012-2013 Yes No First name Last Name Email Address: Home Address: Home Phone: Work Phone: What members of your family might international students meet and interact with? What international experiences do you have? What is your field of work, or what are your career interests? What community and leisure activities do you enjoy? (include cultural and educational activities in which you and your host student might participate): Is there any additional information you would like the student or us to know? Would you host a smoker? Yes No Country/area preferences (we will try to honor your request, but we may not be successful): I have no preference Africa Caribbean Southeast Asia Eastern Europe Latin America Middle East North America Indian Subcontinent Western Europe Other If other, please specify Does anyone in your household smoke? Yes No Do you have pets? Yes No Would you be willing to host two students? Yes No Please list two individuals below who know you well (friends, co-workers, etc.) whom we may contact for a personal reference. Note: Mount Holyoke faculty and staff are not required to supply references. Reference #1 (Name and phone number): Reference #2 (Name and phone number): Please write a short letter below introducing yourself to the prospective host student. Note that the letter will be shared with the student.