Family Application Form
We are so glad you have decided to join the MCS international community as a host or respite care family. Hosting a student is a challenging, but rewarding experience. We are committed to assisting you throughout the entire journey and will do our best to satisfy your needs as a host or respite family.

Get ready for an incredible journey!

Please complete this application form for more information about our homestay or respite care programs.

Marital Status
Family Profile - Parent Information
Father | First and Last Name
Your answer
Father | Date of Birth
MM
/
DD
/
YYYY
Father | Occupation
Your answer
Father | Place of Employment
Your answer
Father | Education Level
Mother | First and Last Name
Your answer
Mother | Date of Birth
MM
/
DD
/
YYYY
Mother | Occupation
Your answer
Mother | Place of Employment
Your answer
Mother | Education Level
Contact Information
Street Address
Your answer
City, State, Zip
Your answer
Home Phone
Your answer
Father | Cell Phone
Your answer
Father | Email Address
Your answer
Mother | Cell Phone
Your answer
Mother | Email Address
Your answer
Children's Information
Please supply us with the (names, birthdates, gender and grades) for each child living in your home. Put N/A if not applicable to your household.
Name, Birthdate, Gender, Grade Level
Your answer
Other Person(s) Living in your Home
Please list information about all other person(s) currently living in your home (Individuals who are over 18 must submit a background check). Put N/A if not applicable to your household.
First and Last Name(s)
Your answer
Email Address(es)
Your answer
Date(s) of Birth
MM
/
DD
/
YYYY
Relationship
Your answer
Home Environment Profile
Family Hobbies
Your answer
Describe a typical weekday in your home:
Your answer
Describe a typical weekend in your home:
Your answer
Do you attend church regularly?
Do you have any pets living in your home?
Please list any animals in your home:
Your answer
Do you have internet access in your home?
Are meals usually eaten inside or outside the home?
Does your family travel often?
What types of outdoor activities do you enjoy?
Your answer
Community Profile
Describe the home you live in:
Your answer
How willing are you to transport a student to various extracurricular activities?
Do you live in a rural or urban environment?
References
Please list two references we may contact.
#1 - Name
Your answer
#1 - Phone
Your answer
#1 - Relationship
Your answer
#2 - Name
Your answer
#2 - Phone
Your answer
#2 - Relationship
Your answer
Letter to Prospective Student
Please provide a brief letter to your future student explaining why you and your family look forward to hosting.
Your answer
Criminal Background Check
Background checks are required for any resident 18 years and older (college students residing at home). Madison Christian School will provide further instructions upon completion of this application. Please note that all members need to submit background checks before the home visit can be scheduled.
Criminal Offense
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? If yes, please explain.
Your answer
Domestic Violence
Have there ever been any incidents of domestic violence within your immediate family? If yes, please explain.
Your answer
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