Host Family Application

Host Family Application
Thank you for your interest in hosting an

international student!

Please note that in order to complete this application you will need to have 3 photos ready to upload. All files must be less that 4MB in size.
- Photo of your family
- Photo of the student's room
- Photo of the outside of your home
You will have the option to include additional photos if desired
Host Father

First Name Middle Name Last Name
Host Father Occupation
Host Father DOB
Host Mother

First Name Middle Name Last Name
Host Mother Occupation
Host Mother DOB
Marital Status *

Home Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

School District
How will student be transported to school?
Email Address *
Email Address
Home Phone

- Area Code Phone Number
Cell Phone *

- Area Code Phone Number
Cell Phone

- Area Code Phone Number
Other than host parents, list all occupants who will be living in the home during the student's stay. Full name, DOB, and indicate if family member is a current Eden Christian Academy student.
Family Member
I am a committed Christian, in good standing with the church I actively attend. *

Yes
Name of Church
Number of students you can host
Gender of student(s) you would like to host (if hosting more than 1 student, they must be of same gender)
Will student have a private room? *
Why do you want to host an international student?
Describe a standard weekday in your home.
List hobbies and/or activities that your family likes to participate in.
List the responsibilities that will be expected of your student.
EX: help clear the dinner table, clean up after self, help take the trash out
List all pets in the home. (State any unusual details if necessary)
Please provide us with 3 non-family member references that we may contact
Reference 1 Name *
Reference 1 Email Address *
Reference 1 Phone Number

- Area Code Phone Number
Reference 2 Name *
Reference 2 Email Address *
Reference 2 Phone Number

- Area Code Phone Number
Reference 3 Name *
Reference 3 Email Address *
Reference 3 Phone Number

- Area Code Phone Number
Background Information
Has any member of your immediate family participated in, been accused or convicted of, or plead guilty or no contest to any type of abuse or sexual misconduct or been convicted or arrested for any criminal offense?
Photos
Upload Family Photo *
Upload Photo of Student's Bedroom *
Upload Photo of Outside of Home *
Additional Photo (optional)

Browse Files

Cancel of
Additional Photo (optional)

Browse Files

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By typing my name below I certify that the information is true.
Type name as signature
Date

- Month - Day Year
Should be Empty:

Host Family Application

Please provide us with 3 non-family member references that we may contact

Background Information

Photos

By typing my name below I certify that the information is true.