Host Family Application

“Having a host family truly showed me the outpouring love of Christ through others”  
— Michael Cox Jr. Anthem Graduate, Class of 2019
Name *
Name
Home Address *
Home Address
Home Phone *
Home Phone
Cell Phone *
Cell Phone
When would your Host Family Home be ready for the student? *
When would your Host Family Home be ready for the student?
Have you completed Six40 Life? *
Are you connected to a Life Group? *
Would you like to have the student be included in your meals? *
Would you like for the student to have chores? *
Would you like to include the student in family activities? *
Have access to the internet? *
Have access to the fridge or have a space reserved for the student's food in the fridge? *
Are there times at the house when it needs to be quiet? *
Do you have a preference for a student gender? *
How many students could you host? *
Home Type *
Number of Bedrooms *
An arrangements would be needed for student to have a bedroom and a bed of his/her own. Does the family have this available? *
Number of Bathrooms *
Does anyone smoke inside the home? *
Have you or any member of your household ever been charged for or convicted of a crime? *