Host Family Application Part 1
Please fill in the questions below with as much detail as possible. Students adjust and acclimate best when having a clear picture of their host family and the home they will be living in.
Host Father Details
Host Father full name
Your answer
Primary contact number (father)
Your answer
Date of birth (father)
MM
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DD
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YYYY
Profession (father)
Your answer
Employer (father)
Your answer
Work phone number (father)
Your answer
Please describe your work schedule including days and hours worked. (father)
Your answer
Please list your interests, activities, sports and community involvement. (father)
Your answer
Host Mother Details
Host Mother full name
Your answer
Primary Contact Number (mother)
Your answer
Date of birth (mother)
MM
/
DD
/
YYYY
Profession (mother)
Your answer
Employer (mother)
Your answer
Work phone number (mother)
Your answer
Please describe your work schedule including days and hours worked. (mother)
Your answer
Please list your interests, activities, sports and community involvement. (mother)
Your answer
Home address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Home phone number
Your answer
Email address *
Your answer
Our Family
Name of the first child/family member
Your answer
Date of Birth of first family member
MM
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DD
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YYYY
Please describe the first family member's personality, hobbies and interests
Your answer
Name of the second child/family member
Your answer
Date of Birth of second family member
MM
/
DD
/
YYYY
Please describe the second family member's personality, hobbies and interests
Your answer
Name of the third child/family member
Your answer
Date of Birth of third family member
MM
/
DD
/
YYYY
Please describe the third family member's personality, hobbies and interests
Your answer
Name of the fourth child/family member
Your answer
Date of Birth of fourth family member
MM
/
DD
/
YYYY
Please describe the fourth family member's personality, hobbies and interests
Your answer
Please list any additional people living in the home.
This is defined as anyone that sleeps two or more nights in the the home each week. Please include name age and relationship. Everyone over 18 must complete a background check.
Your answer
What type of activities does your family enjoy doing together? *
Your answer
Does your family have pets? *
If the answer is yes to pets please give details below. *
Your answer
Does anyone in your home speak another language? If yes, please explain who and which language(s). *
Your answer
What is your family's religious affiliation? *
Your answer
Is it practiced? *
If it is practiced, how often do you attend services? *
We ask our families to invite the students to their church services and activities but we do not require them to attend. Are you comfortable with the student not attending? *
Your answer
Does anyone in your family smoke? *
If yes, please detail who it is and if it in inside or outside.
Your answer
Does your family follow a special diet? *
If yes, please detail below. For example: vegetarian, gluten free, kosher etc.
Your answer
Would you feel comfortable hosting a student who follows a particular diet? *
If yes, please detail below. For example: vegetarian, gluten free, kosher etc.
Your answer
Home & Community
Please describe your home. *
Please include number of bedrooms, bathrooms, yard, etc.
Your answer
Please share your family guidelines and expectations and what you would expect from your international student *
Your answer
Would the student have access to the internet? *
What is the population of your community? *
Your answer
How would you best describe its setting? *
What is its closest major city and how far away is it ? *
Your answer
Please briefly describe your neighborhood and community area *
Please also tell us what is interesting about it. Ex: events, festivals, theaters, sports and sights to see
Your answer
Is there convenient public transport for the student? *
Please explain how they would get around to some of the things listed above
Your answer
How long have you lived in your community? *
Your answer
Will the Student be sharing a room? *
If yes, please specify. Please note: students may only share a room with a child of the same gender and similar age.
Your answer
Will there be any areas of your home that will be off-limits to the student? *
If yes, please specify.
Your answer
Will your children be attending the high school with the student? *
Your answer
How would the student get to school? *
Please tell us why you would like to host an international student? *
Your answer
What kind of experience do you envision for the student living in your home and becoming part of your family? *
Your answer
Have you ever hosted an international student before? *
If yes, please specify program(s), country(ies) and year(s) and what the experience was like for you.
Your answer
Have any of your family members ever visited a foreign country? *
If yes, please specify which family member(s) and which country(ies) and for how long.
Your answer
Please tell us why you feel your family would be a good environment for your guest to live in? *
Your answer
What expectations do you have of your student regarding behaviors, schoolwork, internet/phone use and social activities/ curfew? *
Your answer
CERTIFICATION
By submitting this application, I certify that the contents of this application are true and accurate to the best of my knowledge, and I authorize Xplore Inc.
PLEASE NOTE:
Your personal data will be stored on our secure web-based system. We will use your data to contact you with information pertinent to your application. As per Xplore's Data Protection Policy, we do not share personal data with third parties. By submitting this form, I agree to receiving information regarding my application.
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