Please Note:

By completing this form you hereby give Haiti Lifeline Ministries, Inc. the authority to complete and/or obtain any and all background checks that Haiti Lifeline Ministries, Inc. deems appropriate, including but not limited to criminal background reports and credit reports.

CONTACT INFORMATION
(Please provide information about the sponsor couple the international student would be staying with)
Name *
Name
(Sponsor 1)
Name *
Name
(Sponsor 2)
Home Number *
Home Number
Cell Number *
Cell Number
(Sponsor 1)
Cell Number *
Cell Number
(Sponsor 2)
Address *
Address
(Sponsor 1)
(Sponsor 2)
School Contact Information
(Please provide information about the school the international student would be attending)
School Contact *
School Contact
Contact Phone Number *
Contact Phone Number
FAMILY INFORMATION
(Please answer each question below in 120 words or less)
FINANCIAL INFORMATION
(Please answer each question below in 120 words or less)
Spiritual/Personal Information
(Please answer each question in 150 words or less)
References
Reference 1 *
Reference 1
Phone Number *
Phone Number
Reference 2 *
Reference 2
Phone Number *
Phone Number
Reference 3 *
Reference 3
Phone Number *
Phone Number