Amity Cousin Application

If interested in becoming an Aunt/Uncle to an Amity Intern, please fill out form below. Please note that should we receive an abundance of applicants, preferences will be given to first time Aunt/Uncle families.

The following information will help us match your family with an Amity Intern. PLEASE NOTE that all answers will be kept confidential, and will only be used to match interns with potential Aunt/Uncles.

Please list names and ages of family members living in your household:
How many members in your family?
Family Member #1 - Parent
First Last
Cell or Home Phone
Family Member #2 - Parent
First Last
Cell or Home Phone
Family Member #3 - Child
First Last
Family Member #3 - Age
Family Member #3 - Grade
Family Member #4 - Child
First Last
Family Member #4 - Age
Family Member #4 - Grade
Family Member #5 - Child
First Last
Family Member #5 - Age
Family Member #5 - Grade
Family Member #6 - Child
First Last
Family Member #6 - Age
Family Member #6 - Grade

Preferred Email Address
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Have you previously been a cousin or host family?
- Yes
- No
If so, when?
What about becoming an cousin family interests you?

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