Application To Host A Child
Please scroll down to answer all questions. A $100 non-refundable application fee is due upon completion of form.
Email address *
Have you spoken with a Host Ukraine team member? *
If not, DO NOT complete this form. Please call a Host Ukraine team member to discuss hosting now.
Required
Which Host Ukraine team member did you speak with? *
Your answer
Host Child ID
Name of Child You Wish To Host: *
Include child's (children's) name and ID number
Your answer
First Name - Mother *
Your answer
Last Name - Mother *
Your answer
First Name - Father *
Your answer
Last Name - Father *
Your answer
Cell Phone - Mother *
Your answer
Cell Phone - Father *
Your answer
Date of Birth - Mother *
MM
/
DD
/
YYYY
Date of Birth - Father *
MM
/
DD
/
YYYY
Is mother a US Citizen? *
If NO, state your citizenship status in the Other field.
Required
Has mother ever been convicted of a felony? *
If YES, explain in the Other field.
Required
Current Employer - Mother *
Your answer
How long employed here? *
Your answer
Position/Title: *
Your answer
Employer Address *
Your answer
Employer Phone Number *
Your answer
Employer Email *
Your answer
Is father a US Citizen? *
If NO, explain your citizenship status in the Other field.
Required
Has father ever been convicted of a felony? *
If YES, explain in the Other field.
Required
Father's Current Employer *
Your answer
How long employed here? *
Your answer
Position/Title: *
Your answer
Employer Address *
Your answer
Employer Phone Number *
Your answer
Employer Fax Number *
Your answer
Employer Email *
Your answer
Family Information
Home Mailing Address: *
Your answer
Home Phone: *
Your answer
Primary Email: *
Your answer
Our home has had a Home Study or Home Safety Check within the past 18 months: *
If your Home Safety Check is less than 18 months old, email it separately to info@hostukraine.org. If you need to complete a new one, download the Home Safety Check template (http://hostukraine.org) and email the completed form to: info@hostukraine.org.
Required
Do you have any life change or "disruptive" events that may occur during the host period?
(Examples may include vacations, home remodeling or moving to a new home, wedding or other large family gatherings, planned medical procedures, extended absences from the home, etc.)
Your answer
Children In Your Family
If more than three (3) children dwell in your household, please add their full names, ages, genders, whether they are living in the home full-time, and background check acknowledgement, in the open text box at the end of this section.
Child #1
Full Name
Your answer
Age
Your answer
Gender
Living in the home?
If 18 years or older, I acknowledge that a background check must be done for this child.
Child #2
Full Name
Your answer
Age
Your answer
Gender
Living in the home?
If 18 years or older, I acknowledge that a background check must be done for this child.
Child #3
Full Name
Your answer
Age
Your answer
Gender
Living in the home?
If 18 years or older, I acknowledge that a background check must be done for this child.
ADD ANY ADDITIONAL CHILDREN IN YOUR FAMILY IN THE BOX BELOW:
Full name, age, gender, living in home, background check acknowledgement if over age 18.
Your answer
Background Information
How did you hear about Host Ukraine? *
Your answer
We are interested in hosting an orphan child because: *
Your answer
We are willing to host a chaperone if needed: *
Required
What languages (other than English) are spoken in your home?
Your answer
HOST FAMILY RESPONSIBILITIES
Checking each box indicates understanding of each responsibility and legally binding commitment to compliance by both parents in the host family.
General Responsibilities *
Required
Child Safety *
Required
Mother Initials *
Signing with your initials indicates that you agree to these legally binding responsibilities as a host parent.
Your answer
Father Initials *
Signing with your initials indicates that you agree to these legally binding responsibilities as a host parent.
Your answer
ACKNOWLEDGEMENTS
Checking "YES" indicates legally binding acknowledgement from both mother and father in the host family.
We acknowledge that the host child must be returned to Ukraine on the designated flight. Failure to comply can lead to criminal prosecution. Any late travel expenses are the sole responsibility of the host family. Any and all legal fees incurred due to family noncompliance with program rules and guidelines are the sole responsibility of host family. *
Required
We acknowledge that a background check must be done on for every person living (or spending longer than two (2) consecutive nights in the home during the hosting session) in the household over the age of 18. *
Required
We acknowledge that both parents must complete ALL host parent training provided by Host Ukraine. *
Required
We acknowledge that a home safety check must be on file with Host Ukraine before the host child arrives. *
Required
We certify that our answers are true, accurate, and complete to the best of our knowledge. *
Required
If this application leads to hosting, we understand that false or misleading information may result in our inability to host. *
Required
We commit to submitting photo copies of both parents' drivers licenses, for the safety of our host children. *
Required
Mother Initials *
Signing with your initials indicates that you agree to these legally binding responsibilities as a host parent.
Your answer
Father Initials *
Signing with your initials indicates that you agree to these legally binding responsibilities as a host parent.
Your answer
WHAT YOU MUST COMPLETE SEPARATELY ONLINE:
A background check through this website:
http://gwinvestigations.com/Host-Ukraine.php

The cost is $30/per person over age 18 in your household, which must be paid directly online.

Order your Host Family tee-shirts here:
https://host-ukraine.myshopify.com/collections/frontpage
Please order at least one shirt per family and wear it on arrival & departure day to airport.

WHAT YOU MUST SUBMIT BY EMAIL:
The following items must be submitted by email to applications@hostukraine.org, before your application is complete:
1) photo of mother AND father's driver's license (phone pic sent by email is fine)
2) home safety check
3) three letters of reference (see References, below)
References
Please ask at least three (3) people NOT living in your home to submit letters of reference. Colleagues, clergy, social workers, law enforcement, and friends are acceptable reference sources. Not more than one reference can be from a relative.

Download reference letter format in PDF, here:
http://hostukraine.org/wp-content/uploads/2016/02/Reference-Form-Summer-2016.pdf

Letters of reference must be emailed to <applications@hostukraine.org>, with your family's name in the Subject Line.

Application Fee
A non-refundable $100 application fee is now due via Paypal (info@hostukraine.org) *
Your application will be processed after the application fee is received.
Required
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