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1. First and last name

2. You are a/an...

3. Your address:

4. Please list your interests/hobbies:

5. What languages do you speak?

6. Travel or experience abroad:

7. How many students are you willing to host?

8. Your phone number (this will be given to the student):

9. Your email address (this will be given to the student):

10. Please write names and contact information for 2 personal references:

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