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Host Father
Host Mother
Name
Name
DOB
DOB
Place of Birth
Place of Birth
Citizenship
Citizenship
City
State
Employer
Employer
Position
Position
Annual Income
Annual Income
Home Phone
Work phone
Work phone
Cell phone
Cell phone
Host child from which country - Russia , Ukraine
Have you selected home study agency in your state?
Yes
No
Home Study Agency:
Agency phone number
Can you support the child's travel expenses?
Contact email
Summer 2006 Hosting Program
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