Host Family Application Form for 2020 CHSN Sister School Program
This information will only be shared by the teachers from Yuhigaoka HS, Mrs. Uchiyama and the Japanese student and his/her family in Japan individually.
Email address *
Student's Full Name (first last) *
School *
Student's grade *
Which foreign language is the student currently taking? *
# of Family Members at your house during the Homestay Program *
Family Member 1 -- First Name *
Family Member 1 -- Age *
Family Member 1 -- Relationship to the student *
ex. father, mother, older sister, etc.
Family Member 1 -- Hobbies & Interests *
Family Member 2 -- First Name *
Family Member 2 -- Age *
Family Member 2 -- Relationship to the student *
Family Member 2 -- Hobbies & Interests *
Family Member 3 -- First Name
Family Member 3 -- Age
Family Member 3 -- Relationship to the student
Family Member 3 -- Hobbies & Interests
Family Member 4 -- First Name
Family Member 4 -- Age
Family Member 4 -- Relationship to the student
Family Member 4 -- Hobbies & Interests
Family Member 5 -- First Name
Family Member 5 -- Age
Family Member 5 -- Relationship to the student
Family Member 5 -- Hobbies & Interests
Home Address *
Home Phone Number *
Emergency Contact Person *
Emergency Contact Phone Number *
Will you provide a private room for the Japanese student? *
Do you have any pets at home? How many? *
How does your child go to school? *
How long does it take to commute to school in the morning? *
ex. 20 min.
Does your child participate in any after school activities at school or outside of school? If so, please list the activity/activities. *
Does your family have any food restrictions? *
Do you have any preference for whom you host? (18 girls and 2 boys from Japan) *
Are you willing to host a second student? *
What time does your child usually get up in the morning during weekdays?
What time does your child usually go to bed during weekdays?
What language do you primarily speak in your home? *
Mrs. Uchiyama is planning to take the Japanese students and the host students to Ellis Ireland and Statue of Liberty (tentative) on Monday, March 16th. Do you want to participate in this all-day trip? *
Please write a welcome message to the Japanese student in English and/or Japanese. *
Please write any questions or comments to Mrs. Uchiyama regarding this program.
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