Host Family Application
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.
Should you wish to return to a partially filled form later on click summit and follow the instructions on the following page.
Host Father Details
First Name (father)
Your answer
Middle Name (father)
Your answer
Last Name (father)
Your answer
Primary Contact Number (father)
Your answer
Date of Birth (father)
Day - Month - Year
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
First Name (mother)
Your answer
Middle Name (mother)
Your answer
Last Name (mother)
Your answer
Primary Contact Number (mother)
Your answer
Date of Birth (mother)
Day - Month - Year
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
If your mailing address is different from your physical address, please add it here.
Your answer
Our Family
Please list the Name, D.O.B & Interest of each family member.
Name of the first family member
Your answer
Date of Birth of first family member
MM
/
DD
/
YYYY
Please describe the first family member's personality, hobbies and interests
Your answer
Name of the second 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 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 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 each additional member 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
Please detail if anyone in your household speaks any other languages.
Your answer
What is your family's religious affiliation?
Your answer
Is it practiced
If it is practiced how often do you attend services per month?
Your answer
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 so please detail who it is and if it in inside or outside
Your answer
Does your family follow a special diet
If so 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 so please detail below For example vegetarian, gluten free, kosher etc
Your answer
Our 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 is, for example does it have 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
Student Selection Information
This section of the application is for Xplore MyChoice screening purposes and matching students with families. All information that we receive on the following pages is kept confidential.
My Family can host:
We would prefer to host a student in the:
Do you plan to host any additional students?
If yes, please specify how many, for how long and from which country? please note our students cannot be placed with more than one other student and it has to be from a different language/country
Your answer
Have you had any previous affiliation with hosting, coordinating or monitoring students
If yes, please specify citizenship of your guest, language, activities.
Your answer
Please confirm your family will provide three meals a day for the student, with the exception of lunches, if the student wishes to purchase lunch at school
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