Adult (Primary Contact) *

First

Last

Layout

Email *

Age

Phone *

Profession

Interests and Hobbies / Additional Information

Adult (Secondary Contact)

First

Last

Layout (copy)

Email

Age

Phone

Profession

Interests and Hobbies / Additional Information

Children/Other Household Members

Child 1

Name Child 1

Single Line Text

Age

Gender

At home during visit

yes
no

Interests and Hobbies / Additional Information (Child 1)

child 2

Name Child 2

Age

Gender

At home during visit (copy)

yes
no

Interests and Hobbies / Additional Information (Child 2)

child 3

Name (Child 3)

Age

Gender

At home during visit

yes
no

Interests and Hobbies / Additional Information (Child 3)

child 4

Name (Child 4)

Age

Gender

At home during visit

yes
no

Interests and Hobbies / Additional Information (Child 4)

child 5

Name (Child 5)

Age

Gender

At home during visit

yes
no

Interests and Hobbies / Additional Information (Child 5)

Do you have any pets? Please list name(s), breed(s) and any interesting personality traits/points of interest

Prior Hosting Experience

Any Prior Hosting Experience (If you hosted a World Exchange student please add the name and year they stayed with you).

Housing

Address

Address Line 1

Address Line 2

City

State

Zip Code

Short description of your home/condo/apartment

Short description of your neighborhood

Will the student have their own room or be sharing a room?

Social Interactions

If there are no teenagers in your family, will you be able to introduce your student to other teenagers?

In a few words, how would you describe the general spirit and lifestyle of your family?

What activities do you hope to share during the student's visit

Are you active in your local community or in a local house of worship?

Are there any animals living in the house (some students may have allergies) *

Are there any other features of your famil's lifestyle that you would like to mention? These might include work schedules, weekly events/family nights, allergies, special diets, etc.

Preferences

Who would your prefer to host?

Female Student
Male Student
Group Leader
No preference

Students who have stated that they are non-smokers are expected to respect the no smoking requirement. If your student is one of the rare smokers, will they be allowed to smoke while they are your guest?

Yes
Yes, but not in the house
No

Referals

Are there any friends, neighbors or relative you would suggest who would enjoy hosting a student or group leader? If so please leave their contact information so that we might reach out to them.

Personal Reference 1

Name(s) *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Personal Reference 2

Name(s) *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Apply to Become a Host Family (August 1-20)

Children/Other Household Members

Prior Hosting Experience

Housing

Social Interactions

Preferences

Referals

Personal Reference 1

Personal Reference 2