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Adopt-A-Student 2008 Host Form
*
Required
Errors
First Name
*
Last Name
*
Email Address
*
Address Line 1
*
Address Line 2
City
*
State
*
--
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
FM
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MH
MI
MN
MS
MO
MP
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VI
VT
VA
WA
WV
WI
WY
ZIP Code
*
Home Phone
*
(
)
-
ext.
Do you attend 11 o'clock worship?
yes
no
Can you provide transportation for the student, if needed?
yes
no
Family members, with children's ages:
What are your interests/hobbies/activities?
Do you have pets, and if so, what kind?
Describe the type of relationship you would like to have with a student:
Is there anything else you would like us to know as we match students with families?
Please contact Donna Hatfield (donnalhatfield@gmail.com or 704-895-4959) if you have questions.
Last Published: August 6, 2008 11:12 AM
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