2018 Host Family Application
Email address *
Parent 1 Name (First, Last) *
Your answer
Parent 1 Cell phone *
Your answer
Parent 1 Occupation and Work phone # *
Your answer
Parent 2 Name (first, last)
Your answer
Parent 2 Cell phone
Your answer
Parent 2 Occupation & Work phone #
Your answer
Main email address (most communication will be through email) *
Your answer
Which group are you interested in hosting? *
Home Address (Street Address, City, Zip) *
Your answer
Is smoking allowed? *
Will the student have his/her own room? *
Student Perference *
Family Pets (list type of pet and number~ mention if they are indoor or outdoor pets) *
Your answer
Family Interests/Hobbies *
Your answer
List all host family children living in the home (Name, Gender, Age) *
Your answer
Is any one else living in the house during the homestay? *
Can you provide a Drivers License # of each adult (over 18) at the time of the home visit? *
Has anyone living in the home been convicted of a felony? *
Local Reference #1: Name, Phone, Relationship *
Your answer
Local Reference #2: Name, Phone, Relationship *
Your answer
Comments/Questions/Special Circumstances
Your answer
Do you have any friends or family who would be interested in hosting an exchange student as well? Please provide name, phone number, and/or email address
Your answer
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