Host Family Application
Tell us more about you and your family
Who lives in your house hold?
Wife
Husband
Partner
Children
Single
Family member
House guest
First Host Parent First Name and Last Name
First Host Parent Date of birth
First Host Parent Occupation
Second Host Parent First Name and Last Name
Second Host Parent Date of birth
Second Host Parent Occupation
Address
Phone Number
Email
Did someone refer you to this program? If Yes please list their name.
Do you have someone you would like to refer as a host family? If so please list their name, and fill in their contact information below!
Referal Phone Number
Referal Email
Please list the names of each family member in your household below.
Name of all Children or Child, if none please say NONE
Children or Child's Date of birth
Do any of your children live away from home?
Name of other member(s) living in your household. If none please say NONE.
If YES, please state the relationship of the member(s)
Member(s) occupation
Member(s) Living Situation?
Have you hosted a student before? If YES, please explain:
Let's talk about your home! How can you best describe your home?
Please choose the type of home you live in
Apartment/Condo
Townhome
House
Are you located near a bus stop?
Yes
No
If you are located near public transportation, please indicate how long it will take the student to walk to the stop?
Are you willing to drive the student to and from the stop or school?
Yes
No
Are you near any universities or schools? if YES, please list the school names.
How many bedrooms do you have available?
1 room
2 rooms
3 rooms
4 rooms
other
Please describe the bedroom in your home that is available. Please check all that apply:
Private bedroom
Private bathroom
Shared bedroom
Shared bathroom
Do you have a backyard pool?
Yes
No
Community Pool
Do you have internet service in your home?
Yes
No
Do you have in-home Laundry
Yes
No
Nearby Laundry facility
Do you have parking available if a student has a car? If YES, indicate where (street, garage, driveway)
Lets get to know you and your family more personally
Please describe more details below!
Please check on which best qualities best describes your family
Eat dinner together at least 3 nights a week
Enjoy spending family quality time together
Eat dinner at different times due to different schedules in the family
Enjoy indoor or outdoor activities with the family
Easy going/ spend time relaxing in the evenings
See other family members outside our home
Enjoy Shopping with family
Enjoy going the movies or watch movies at home with family
Enjoy playing video games with family
Arts and Crafts time with family
Playing Sports with family
Please tell us about your personal or family hobbies?
What do you want to gain from being a host parent?
Anything else you would like to add that best describes your family
Do you have pets? If so please how many you have and what breed.
Your Student Request Preferences
Please review below to make a request of your students
Gender
Male
Female
No preference
Age range (Please select all that applies)
18 and over
13-17
9-12
How many meals are you willing to provide during a week? Select all that applies.
1 meal/Breakfast
2 meals/Breakfast/Dinner
3 meals/Breakfast/Lunch/Dinner
2 + meals including weekends/Breakfast/Dinner/ + lunch on weekends
Does your family allow smoking?
No
Yes
Does your family allow drinking alcohol if over the age of 21?
Yes
No
Any other student request you would like to ask?
Please upload a family photo
Select a File
Thank you for sharing your families information
Please name a references we can contact
Email
Phone Number
Your Signature
*
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