FLEX Host Family Application

Thank you for applying to be a host family for the US Department of State’s Future Leaders Exchange (FLEX) Program. This program is seeking volunteer families to host an exchange student for the 2012-2013 academic year.

Hosting a FLEX student is a wonderful opportunity to expose your family to a new culture and open your home to a promising young leader that has been selected through a highly competitive vetting process based on their academic excellence, outstanding character, and English language abilities. All students come from Eurasian countries (Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, and Ukraine) and are between 15-17 years old.

Thank you for your interest in being a host family for this program!

Question Title

* 1. Please select the FLEX host organization in your community that contacted you about this opportunity.

World Affairs Council - Kentucky and Southern Indiana

WorldChicago

International House - Charlotte, NC

Colleagues International - Kalamazoo, MI

World Learning/Center for International Programs - DC

Question Title

* 2. Parent 1/Guardian Information

Parent Name (Last, First, Middle):

Date of Birth (MM/DD/YYYY):

Age:

Sex:

Place of Birth (City and State/Country):

Country of Citizenship:

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* 3. Parent 1/Guardian Contact Information

Permanent Address: #, Street, City, State, Zip Code:

Home Phone:

Cell Phone:

Email:

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* 4. Parent 1/Guardian Employer Information

Name of Employer

Work Address

Job Title

Telephone