FunctionsSubsConstants  

Host Family Application


Application Date:    
We are delighted that you are interested in hosting a Chinese student during the 2016/2017 school year.
BE SURE TO ENTER AT LEAST FAMILY NAME, CONTACT EMAIL AND HOME ADDRESS. YOU CAN RETURN TO COMPLETE THE REST OF THE APPLICATION LATER.
Please do not use the back arrow!

Problems completing the application? Please contact our U.S. Representative, Linda Nelson, lnel@comcast.net.

     
Host family

Family Name          Contact email

address city
state zip
Main contact phone

Family members - Parent(s)

First Name Last Name
Contact Phone Email
Employer
Do you speak any languages other than English? If so, what language?
Please list this person's interests. (E.g. activities, sports, hobbies, topics of interest, etc.)
First Name Last Name
Contact Phone
Email
Employer
Do you speak any languages other than English? If so, what language?
Please list this person's interests. (E.g. activities, sports, hobbies, topics of interest, etc.)

 

Other family member(s)

Please check the box below if there are no other family members.
none   
First Name Last Name
DOB Gender   Female      Male  
Occupation school Name
Grade
Please list this person's interests. (E.g. activities, sports, hobbies, topics of interest, etc.)
First Name Last Name
DOB Gender   Female      Male  
Occupation school Name
Grade
Please list this person's interests. (E.g. activities, sports, hobbies, topics of interest, etc.)
First Name Last Name
DOB Gender   Female      Male  
Occupation school Name
Grade
Please list this person's interests. (E.g. activities, sports, hobbies, topics of interest, etc.)

 

y
Describe a typical week day in your home
Describe how you would hope to see your student interact with your family
(daily activities, evenings at home, family outings)
Does anyone living at home have
any chronic conditions that might affect the student? If so please list.
Yes      No       List  
Do you have pets?   
Yes      No      cat      small dog      big dog      other  
List other   
Have you hosted before?
Yes      No  
Was it a positive experience?
Yes      No  
Do you prefer the student to be?
Female   Male     doesn't matter  
How many international students would you like to host at same time? One     Two  
Will you host a student with minor allergies?
Yes      No  
Are you willing to host a student who has dietary restrictions (e.g. vegetarian, vegan, no pork, etc. that could require additional effort to maintain and could affect the normal routine of family meals.)?
Yes      No  
How many rooms?       Number of bedrooms       Number of Bathrooms   
Which type of room will the student have?         Shared         Separate  
Will the student have access to:      Internet       Wi-Fi  
If no home phone, will you ensure the student has access to a cell phone?
This does not mean you will pay for the cell phone, only that you will immediately provide access to a cell phone to ensure the student has a way of communicating in an emergency while in the host family home alone.
Yes      No  
Are you willing to provide reasonable transportation to and from school and social activities when needed?
Yes      No  
How will the student get to and from school and activities?
   walk      school bus      public transportation      other  

   list other method  

Type of community

Suburban        Urban        Rural           Population    
Name of nearest major city:    
    
Distance in miles    
    
Population    
Is there convenient public transportation available to get there?     Yes      No  
Nearest airport:          Distance in miles from your home    
What points of interest are near your area? (parks, museums, historical sites, amusement parks, theaters, malls)