Please download the form, fill it out, and either
  • 1) Scan and e-mail it to mthomas@unm.edu
  • 2) Bring it to the Honors College Office (lower level Student Health Bldg.)
  • 3) Mail it to:

M. Thomas/ConexionesHonors College, SHC #21MSC06 38901 Universtiy of New MexicoAlbuquerque, NM 87131


download

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HOST FAMILY PLACEMENT FORM

You will need this info. to fill out the downloaded form

1. Participant
Last name:
First name:Home address: City/State:
Email:
Phone: ­­
Date of birth:
Nationality:
Native language:
Knowledge of other languages:
Sex:
Major:
Special hobbies:
Please indicate the name of a person who can be contacted in case of emergency (name, phone number, email address)

2. Desired host family:
Family with children?
Family with pets?

3. Comments regarding special dietary requirements (Are you vegetarian or have certain food preferences?)


4. Allergies? (If you have any allergies, describe them, please.)


5. Do you have any special physical conditions that must be taken into account by the travel agency when planning the different excursions included in the program?
If yes, specify them.