CS - Homestay Family Application

Host Name *

First Name Last Name

Date of Birth *

Month Day Year

Marriage Status *

Ethnicity/Race *

Employment Information

Employment Status *

Position/Title *

Employer *

Education Background

Highest Degree/Diploma Earned *

Where did you attend? *

Major/Minor(s) *

Contact Information

Cell Phone Number *

Home Phone number if not same

Primary Email *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Please tell us a little more about your home, family, and expectations in this section

Type of Home *

Number of Bedrooms in Home *

Number of People Living in Household *

Number of Children Living in the Household *

How soon is the space in you home available? *

How many rooms are available? *

Location of open room in house *

Do you have hosting experience? *

Yes No

Total amount of time you have hosted *

Do you own any pets? If so, what kind and how many *

Co-Host Name

First Name Last Name

Date of Birth

Month Day Year

Ethnicity/Race

Relationship to Host

Employment Information

Employment Status

Employer

Position/Title

Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Education Background

Highest Degree/Diploma Earned

Where did you attend?

Major/Minor(s)

Other Family Members

Name

First Name Last Name

Date

Month Day Year

Relationship to Host

Occupation/School

Add Another?

Yes

Name

First Name Last Name

Date

Month Day Year

Relationship to Host

Occupation/School

Thank you so much for signing up to join the Cornerstone Education Family! The homestay coordinator will contact you within 24 hours of this form being submitted to inform you the application has been received. Then a phone call will be scheduled to go over the information you have submitted and to schedule a home visit.

How did you hear about us? *

Applying to be a Host Family