2014-15 Paris Homestay Questionnaire

1. Default Section

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* 1. Name:

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* 2. Major

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* 3. What are your hobbies and interests?

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* 4. What is your father's occupation?

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* 5. What is your mother's occupation?

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* 6. Have you ever lived with a host family for an extended period? Has your own family ever hosted a foreign exchange student? If so, please describe your experience.

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* 7. Have you ever lived abroad? If so, for how long?

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* 8. Do you smoke?

No.

Yes, occasionally.

Yes, regularly.

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* 9. Please indicate your tolerance for living in a household with smokers.

I wouldn't mind living in a household with smokers.

I'd prefer not to live with smokers.

I can't live with smokers for the health reasons explained below.

Health reasons:

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* 10. Please describe your dietary needs. Are you a vegetarian? Do you keep kosher? Do you have food allergies? Please give details.

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* 11. Are there any foods you do not eat? If so, please list below.

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* 12. I tend to:

try out lots of different foods

try different foods but within certain limits

be a "picky" eater

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* 13. Would you like to live in a household with pets?

I'd love it!

I wouldn't mind.

I'd prefer not to live with any pets.

Please explain any preferences here (e.g., I love dogs, but am allergic to cats).

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* 14. Would you like to live in a household with children?

I'd love it!

I wouldn't mind.

I'd prefer not to live with children.

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* 15. Do you play a musical instrument? If so, which one?

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* 16. Do you have any health concerns that should be taken into account when placing you with a host family?

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* 17. Do you have any allergies (not including food)? Please list them and explain their severity.

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* 18. In general, would you prefer to be integrated into family life or left more to yourself? Please explain.

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* 19. What would you say is your best characteristic, as far as living with others is concerned?

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* 20. What is your worst?

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* 21. Adjusting to life in a different culture isn't easy. What do you think you will find most challenging during your year abroad? How do you suppose you will deal with this challenge?

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* 22. Finally, is there anything else that you believe we should know about when we determine where you will live next year? Would you care to communicate to us information about your particular work habits, medical problems, sexual orientation, religious observance, or any other aspect of your personal life that could have an impact on your well being while living with a host family in Paris? This information, potentially useful to the Associate Director when placing you in a French family, will be kept strictly confidential and will not be shared with anyone in your host family without your explicit permission.