Long Term Host Family

Long Term Host Family Application Form


Please fill out and submit the form below

(Fields marked with an * are mandatory)

Family Name*

Which school will the international students you are interested in hosting attend?

Home Address*

City*

State*

Zip Code*

Home Telephone*

Email Address*

Primary Contact

Host Father

Name*

Date of Birth

Occupation

Employer

Work Telephone

Cell Phone

Host Mother

Name*

Date of Birth

Occupation

Employer

Work Telephone

Cell Phone

Can we share your cell phone numbers with other hosts in your area to assist with student gatherings, carpooling, etc?

Other Family Members

Member 1

Name*

Gender

Age*

School Name

Relationship to primary contact*

Does he/she live at home?*
 Yes No

Pet Information

Pet 1

Species

Pet Name

Size

Breed

Religion

Host Mother

Host Father

Details

Schedule and Hobbies

International students who apply for home stay look forward to spending time with their host family in the evenings and on weekends. Host families are expected to involve students in family activities, outings and events, which will familiarize students with American culture and will help them to feel at ease with your family and your home.

Please give a general description of your family’s normal daytime routine and evening / weekend commitments:

Weekday

Weekend

What kind of leisure activities can you offer to a student?

Eating Habit

Do you have any special dietary practices or restrictions?

Household

Do any of your family members smoke?

Will the student share a bedroom?

With Whom

Will the student share a bathroom?

With Whom

Have you ever hosted an Exchange Student?

Which Program(s)

Do you have wifi at home?

Describe your expectations regarding the responsibility and behavior of the student while in your home.(e.g. homework, chores, etc.)

Do you have any preference regarding the gender of your host student(s)?

How many students would you like to host?

How far is your home from the school?

What type of transportation will be provided to and from the school? If school buses service your area, students are allowed to take them.

Please share some photos of your family and home with the student! (The sum size of all files should be less than 30MB. If you have any trouble uploading photos, please email them directly to hostfamily@iperc.org)

1. Photo of outside of home

2. Student bedroom

3. Bathroom student will use

4. Living/family room

5. Kitchen

6. Back yard

7. Family photograph

Message for the students

Other

Where did you hear about us?

Agreement*