Personal Information          Name:                   Family Name          Given Name(s)          Home Address:                   Telephone Number:                   Include country and city code          E-mail Address:                   Date of Birth:                   /                   /                   Age:                   Day          Month          Year          Sex:                   Male                   Female          Physical Description:          Height:                   Weight:                   Hair Color:                   Eye Color:                   Father's Name:                   Family Name          Given Name(s)          Occupation:                   Business Number:          Include country and city code          Mother's Name:                   Family Name          Given Name(s)          Occupation:                   Business Number:          Include country and city code          Brothers and/or sisters:          Name:                   Age:                   Name:                   Age:                   Name:                   Age:                   Do you live with your parents?          Yes          No          If No, how far away from your parents do you live?                   If No, who lives with you?                   If Yes, have you ever lived away from your parents?          Yes          No          How far away, and how long?                   Do you live in...          A big city (more than 1 million people)          A small city (100,000 - 1 million people)          A small town (25,000 - 100,000 people)          A rural town (fewer than 25,000 people)          Preferences, Interests, and Hobbies          Do you smoke?          Yes          No          Would you live with others who smoke?          Yes          No          Do you drink alcohol?          Yes          No          Would you live with others who drink?          Yes          No          Do you likepets?          Yes          No          List any pets you have at home:                   List any animals that you do NOT like:                   Do you have allergies?          Yes          No          If yes, please explain:                   Do you have any health problems?                   What are your hobbies?                   Describe your normal activities during the week (Monday through Friday afternoon).                   Describe what you enjoy doing on the weekend (Friday evening through Sunday).                   What is your religious affiliation?          Catholic          Protestant          Muslim          Buddhist          Nonreligious          Other          How often do you attend church?          Weekly          Monthly          On Holidays          Never          Would you be willing to live with a host family of a different religion?          Yes          No          Please list any foods that you cannot or do not like to eat (pork, beef, etc.):                   Please list some foods that you enjoy eating:                   What is your occupation, or in what field of study are you interested?                   Please describe your personality:                   Please list any languages that you speak:          Language          Years of Study          Proficiency Level                                                                                           Every host family is different, and ECI ELP's homestay coordinator will do his or her best to find a perfect match. Please indicate what kind of host family you do NOT want to live with.          I prefer not to stay with:          A single man          A single woman          Hosts who are under 30 years of age.          Hosts who are over 70 years of age.          A single man with children who live at home.          A single woman with children who live at home.          Hosts who have children.          Hosts who have children under six years old living at home.          Hosts who have children over eighteen years old living at home.          Hosts who have cousins, grandparents, etc. that are living with them.          Other: