Host Application
Please fill out the application as complete as possible as this will accelerate the certification process so that we can schedule your interview if you are near the schools that we are currently working with. Thank you for your interest in homestay.
Applicant First Name *
Your answer
Applicant Last Name *
Your answer
Birth date *
MM
/
DD
/
YYYY
Occupation *
Your answer
Any other members living in the home:
*All members over 18 years of age in household are required to have a background check completed
Name - Relationship - Age & Date of Birth of Other Members
Your answer
Street Address *
Your answer
City State Zip *
Your answer
Phone *
Your answer
Additional phone *
Your answer
E-mail *
Your answer
Language spoken in the home *
Your answer
Secondary language
Your answer
Has anyone in the household been charged or convicted of a crime? *
If yes, please explain: What crime?
Your answer
When was it committed?
Your answer
How many rooms do you have available for students? *
Your answer
Will students be sharing a bathroom? *
If so, with whom?
Your answer
Does the room have a bed, desk, chair, lamp and drawers/hanging space for clothes? *
Are you able to host a student for longer than 6 weeks? *
Are there any dates that you are NOT available? *
Please list
Your answer
Would you consider hosting a student under the age of 18? *
Are there any nationalities you object to hosting? *
If so please list
Your answer
Are you willing to provide meals for the student (most students do request meals)? *
Are you willing to accommodate special diets?
Do you have wireless access available for the student at no charge? *
Will you permit smoking outside? *
Will you permit alcohol if the student is over the age of 21? *
Do you have pets? *
# of Dogs
Your answer
# of cats
Your answer
# Other
Your answer
What kind?
Your answer
Do you prefer students that are *
What colleges are you located near? *
Distance via Bus/light rail?
Your answer
Distance via Bus/light rail? *
Please map in minutes from Google Maps
Your answer
What are your normal work hours? *
Your answer
Have you hosted an international student before? *
Why is your family interested in hosting an international student? *
Your answer
What, if any is your religious affiliation? *
Your answer
What sort of activities, hobbies or sports do you and/or your family enjoy? *
Your answer
How did you hear about Arizona Homestay? *
Your answer
Please give us 2 personal local references *
Name - Phone - Relationship
Your answer
Please let us know about any special requests or activities we should take into account when matching you with a student:
Your answer
Please share with us any other information that you would like our students to know that would help introduce you and/or your family. The more information, the better. Please include any information about your community that would be helpful to the student:
Your answer
I certify that the above information is correct to the best of my knowledge. If provided information is shown to be incorrect, the application will be null and void and above applicant will not be able to host with Arizona Homestay. By signing the application electronically, I authorized Arizona Homestay to verify the above information.
Name (Sign) *
Your answer
Date *
MM
/
DD
/
YYYY
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