Le Monde Immersion Host Family Questionnaire
Please answer the following questions. Your answers will help the Host Family Committee determine the best fit, for both our interns and our host families. Merci!
First and Last Name(s)
Your answer
Email Address(es)
Your answer
Home phone
Your answer
Cell phone(s)
Your answer
Address
Your answer
Names of all family members that reside in the house and ages/grades of the children:
Your answer
Do the host parents speak English fluently?
Does your family speak French as well? If so, how much, and with what frequency?
Your answer
Do you have a preference or a requirement to host in the fall?
Do you have a preference or a requirement to host in the winter?
Do you have a preference or a requirement to host in the spring?
If possible, would you be willing to host an intern for fall/winter or winter/spring?
Are you open to hosting an intern in either the fall, winter, or spring, based on the school’s needs?
Do you have a preference to host a male or female intern? I prefer:
Does your family have pets in the home? If yes, please describe.
Your answer
Describe the bedroom set up for your possible intern. Will you provide a private room that meets fire code safety standards for the intern in your home? Is there a window? A closet?
Your answer
What are the main reasons you want to host an intern?
Your answer
Do you or anyone in your household smoke?
Does your family have any special dietary restrictions or diets that the intern should be made aware of (are you gluten free, vegetarian, etc.)?
Your answer
What bus/train lines is your home near; how do you anticipate the intern will ride to school; what sort of transportation is available near your home (please include the distance to nearest stops as well).
Your answer
Please describe activities your family likes to partake in. What does a typical weekend look like?
Your answer
Do any members of your family have a specific medical condition that the intern should be aware of?
Your answer
Does your household maintain religious, cultural practices or dietary restrictions of which the intern should be made aware?
Your answer
Have you or any member of your immediate family been convicted of an offense other than a minor traffic violation? If yes, please explain.
Your answer
Describe other household help (live-in or live-out) such as cleaning service, housekeeper, yard maintenance, etc. Include frequency of visits.
Your answer
Is there anything else you feel the committee should be aware of?
Your answer
Thank you for participating!
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