International Host Family Search

The International Programs office will locate housing for a non-refundable fee of $125 (USD). To help place you with a host family that best suits you, please complete this form.

Your contact information

First Name		(Alt+a)
Last Name		(Alt+b)
Address 1		(Alt+c)
Address 2		(Alt+d)
Suite/Apartment		(Alt+e)
City		(Alt+f)
State		(Alt+g)
Country		(Alt+h)
Postal Code		(Alt+i)
E-mail		(Alt+j)
Telephone		(Alt+k)
Fax		(Alt+l)

Your personal information

Nationality		(Alt+m)
Language		(Alt+n)
Citizenship		(Alt+o)
Birth Date	(select month) January February March April May June July August September October November December	(Alt+p)
	(select date) 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	(Alt+q)
		(Alt+r)
Gender	(select) Male Female	(Alt+s)
Status	(select) Single Married	(Alt+t)
Health	List any health concerns or physical disabilities:	(Alt+u)
Allergies	List any food or animal allergies:	(Alt+v)
Housing Preferences	(select) Home with pets Home without pets Don't care	(Alt+w)
	(select) Home with children Home without children Don't care	(Alt+x)
Transportation	(select) Walk or ride bus to college Drive personal car	(Alt+y)
Length of Stay	(select) 1 quarter term 2 quarter terms 1 school year 2 school years Other	(Alt+z)
	If other, please explain:	(Alt+A)
Other	Do you smoke? (select) Yes No	(Alt+B)
Other	Do you drink alcohol? (select) Yes No	(Alt+C)
	If yes, how often?	(Alt+D)
Sports	What sports do you like?	(Alt+E)
Hobbies	What are your hobbies?	(Alt+F)
Career	What are your career interests?	(Alt+G)
Additional Information	About yourself or the host family you would like:	(Alt+H)

Emergency contact information

First Name		(Alt+I)
Last Name		(Alt+J)
Address 1		(Alt+K)
Address 2		(Alt+L)
Suite/Apartment		(Alt+M)
City		(Alt+N)
State		(Alt+O)
Country		(Alt+P)
Postal Code		(Alt+Q)
E-mail		(Alt+R)
Telephone		(Alt+S)
Fax		(Alt+T)

After submitting, please approve transmission of this form via e-mail. Thank you.

(Alt+U)

Contact International Programs

Laju Nankani, Director
Centralia College
600 Centralia College Blvd.
Centralia WA 98531-4099 USA
E-mail: intl@centralia.edu
Phone: (360) 736-9391, ext. 492
Fax: (360) 330-7503