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 NameMiddle NameLast Name
Host Father Occupation
Host Father DOB
Host Mother

First NameMiddle NameLast Name
Host Mother Occupation
Host Mother DOB
Marital Status*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
School District you reside in
How will student be transported to school?
Average travel time to school
Email Address*
Email Address
Home Phone

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Other than host parents, list all occupants who will be living in the home during the student's stay. Full name, DOB, and list occupation or grade level.
Family Member
Religious Affiliation*
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?*
Is the bedroom in the basement*
Does the bedroom have a window?*
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 or chores 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)*
List any special dietary plans you follow or any special circumstances in the home*
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 CodePhone Number
Reference 2 Name*
Reference 2 Email Address*
Reference 2 Phone Number

Area CodePhone Number
Reference 3 Name*
Reference 3 Email Address*
Reference 3 Phone Number

Area CodePhone 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 a File

Cancelof
Upload Photo of Student's Bedroom*

Upload a File

Cancelof
Upload Photo of Outside of Home*

Upload a File

Cancelof
Additional Photo (optional)

Browse Files

Cancelof
Additional Photo (optional)

Browse Files

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

MonthDayYear
Should be Empty:

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.