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Student name:
Gender: male female
Email address:
Select a password: (8 char min)
Please confirm:
Home city:
Home country:
Region (ie. state or province):   
 
Destination country:USA
Destination region:Illinois
Destination city:Chicago (including surrounding area)
Which school will you attend?
 
Arrival date:year month day
Departure date:year month day
 
How much are you willing to spend?  $ American (numbers only, no commas or symbols)
Should this include meals? yes no
(if yes) breakfast yes no
(if yes) lunch yes no
(if yes) dinner yes no
 
Do you smoke? yes no
Do you mind pets? yes no
 
What would you like to accomplish during your visit?



Please introduce yourself to your homestay family:



Today's date: 2017-05-25