Friendship Family Volunteer Information
 

Please give the name, gender and occupation of household members.
First Last Gender Occupation
First Last Gender Occupation
How would you describe
your family age?		 Young Middle-aged Senior  

Other household members.

First Last Gender Age
First Last Gender Age
First Last Gender Age
Address Street:
City: Zip Code:
Contact
Info 		Home Phone: Work Phone:
E-mail: Cell
Phone
Preferred method of contact: Home Phone, Work Phone, Cell Phone, E-mail
Countries that you have lived or worked in.
Languages that you speak or have an interest in.
Do You smoke? Yes No Do you have pets?

Yes No

What kind of pet?

What kind of student do you have a preference for? (Check all that apply)
male
female
single
married
no preference
How often are you willing to meet with your student? Once a semester Once a month More Often
Community Affiliations:
Interest / Hobbies :
How did you learn about the Friendship Family program?:
Personal Reference
  Name Relationship Phone / Email
. Phone:
Email:
List Best times to contact you
Which other CVIP Committees interest you? (Check all that apply)
Coffee Partners
Couples Supper Club
Every Tuesday
Friendship Family Program
Global Festival
Lending Center
Scholarship Program
Speakers Bureau

  
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